Provider Demographics
NPI:1134770258
Name:CONVENTIONS RX, LTD
Entity type:Organization
Organization Name:CONVENTIONS RX, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-416-8289
Mailing Address - Street 1:1560 WALL ST STE 304
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-1262
Mailing Address - Country:US
Mailing Address - Phone:630-416-8289
Mailing Address - Fax:630-416-8307
Practice Address - Street 1:1560 WALL ST STE 304
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-1262
Practice Address - Country:US
Practice Address - Phone:630-416-8289
Practice Address - Fax:630-416-8307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic NeuroimagingGroup - Single Specialty