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Organization
ILLINI CLINIC PHARMACY INC
Active
Organization
ILLINI CLINIC PHARMACY INC
Active
Other names
RidgeWood Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DONNA MERIDETH (OWNER)
(309) 781-5770
Entity
Organization
Contact information
Practice address
103 N PROSPECT ST, CAMBRIDGE, IL 61238-1148
(309) 781-5770
Mailing address
855 ILLINI DR STE 200, SILVIS, IL 61282-2908
(093) 792-7002
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
054-021593
STATE LICENSE
IL
01
—
320-013281
CONTROLLED SUBSTANCE LICENSE
IL
Enumeration date
07/01/2020
Last updated
11/27/2023
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