Organization
CRITICAL CARE RX, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAM ENLOE (MEMBER)
(618) 339-4211
Entity
Organization
Contact information
Practice address
126 OAK ST, PEORIA, IL 61602
(833) 352-0966
Mailing address
1884 LACKLAND HILL PKWY STE 6, SAINT LOUIS, MO 63146-3569
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
54-020902
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
054.020902
PHARMACY
IL
01
—
54-020902
PHARMACY LICENSE
IL
Enumeration date
07/03/2018
Last updated
11/22/2021
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