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Organization
MEDWELLRX II LLC
Active
Organization
MEDWELLRX II LLC
Active
Other names
MedWellRx II LLC
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY DECKER (CEO)
(402) 763-6560
Entity
Organization
Contact information
Practice address
600 NORTHGATE PKWY STE C, WHEELING, IL 60090-3201
(847) 459-7011
(847) 459-7036
Mailing address
11134 Q ST, OMAHA, NE 68137-3609
(402) 592-5244
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
320.009686
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1484079
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
02/05/2010
Last updated
02/05/2010
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