Medwellrx II LLC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

License

320.009686 Issued in IL

Legal business name

MEDWELLRX II LLC

Practice address

600 Northgate Pkwy Ste C
Wheeling, IL 60090-3201

Phone

(847) 459-7011

Fax

(847) 459-7036

NPI assigned

Feb 5, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Timothy Decker

Title

Ceo

Phone

(402) 763-6560

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• MedWellRx II LLC Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1265328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265328000000",
    "number": "1609108356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11134 Q ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681373609",
            "telephone_number": "402-592-5244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 NORTHGATE PKWY STE C",
            "city": "WHEELING",
            "state": "IL",
            "postal_code": "600903201",
            "telephone_number": "847-459-7011",
            "fax_number": "847-459-7036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDWELLRX II LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-05",
        "last_updated": "2010-02-05",
        "status": "A",
        "authorized_official_last_name": "DECKER",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "402-763-6560"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "IL",
            "license": "320.009686",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "1484079",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MedWellRx II LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.