# ILLINI CLINIC PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356561039
- **Authorized official:** MR. JEFFREY R MERIDETH RPH (PRESIDENT)
- **Authorized official phone:** (309) 792-7002

## Contact information

- **Practice address:** 855 ILLINI DR, SUITE 200, SILVIS, IL 61282-2907
- **Practice address phone:** (309) 792-7002
- **Practice address fax:** (309) 792-7003
- **Mailing address:** 855 ILLINI DR, SUITE 200, SILVIS, IL 61282-2907
- **Mailing address phone:** (309) 792-7002
- **Mailing address fax:** (309) 792-7003

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 054013807 | IL | Yes |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 04/26/2007
- **Last updated:** 07/01/2020