# ILLINI CLINIC PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Alwood Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053838458
- **Authorized official:** DONNA MERIDETH (OWNER/PIC)
- **Authorized official phone:** (309) 629-4506

## Contact information

- **Practice address:** 211 S. 1ST ST, ALPHA, IL 61413-0355
- **Practice address phone:** (309) 629-4506
- **Practice address fax:** (309) 629-2611
- **Mailing address:** PO BOX 355, ALPHA, IL 61413-0355
- **Mailing address phone:** (309) 629-4506
- **Mailing address fax:** (309) 629-2611

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 054020443 | IL | Yes |

## Other

- **Enumeration date:** 08/25/2017
- **Last updated:** 07/01/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2169798 | PK | — |