Provider Demographics
NPI:1124546031
Name:SYMBRIA RX SERVICES, LLC.
Entity type:Organization
Organization Name:SYMBRIA RX SERVICES, LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-981-8150
Mailing Address - Street 1:7125 JANES AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-2304
Mailing Address - Country:US
Mailing Address - Phone:630-981-8000
Mailing Address - Fax:
Practice Address - Street 1:3200 GRANT ST RM 41
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1903
Practice Address - Country:US
Practice Address - Phone:847-492-4827
Practice Address - Fax:847-570-3465
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SYMBRIA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-31
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0540203513336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL054020351OtherPHARMACY STATE LICENSE NUMBER