Organization
ILLINI CLINIC PHARMACY INC
Active
Other names
Alwood Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DONNA MERIDETH (OWNER/PIC)
(309) 629-4506
Entity
Organization
Contact information
Practice address
211 S. 1ST ST, ALPHA, IL 61413-0355
(309) 629-4506
(309) 629-2611
Mailing address
PO BOX 355, ALPHA, IL 61413-0355
(309) 629-4506
(309) 629-2611
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054020443
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2169798
PK
—
Enumeration date
08/25/2017
Last updated
07/01/2020
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