Provider Demographics
NPI:1760805089
Name:SPECIALTY CARE RX, LLC
Entity Type:Organization
Organization Name:SPECIALTY CARE RX, LLC
Other - Org Name:SPECIALTY CARE RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:P
Authorized Official - Last Name:HARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:609-457-0814
Mailing Address - Street 1:5310 N SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-2514
Mailing Address - Country:US
Mailing Address - Phone:773-769-6200
Mailing Address - Fax:773-769-6201
Practice Address - Street 1:5310 N SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2514
Practice Address - Country:US
Practice Address - Phone:773-769-6200
Practice Address - Fax:773-769-6201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054018467333600000X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy