Organization
AGELESS RX SYSTEMS LLC
Active
Other names
Sulivan Drugs of Gillespie
Organization subpart
No
Provider details
NPI number
Authorized official
TERRY ALLAN PHARM D. (OWNER)
(217) 839-2877
Entity
Organization
Contact information
Practice address
103 N JERSEY ST, SUITE 101, GILLESPIE, IL 62033
(217) 839-2877
(217) 839-3233
Mailing address
103 N JERSEY ST, SUITE 101, GILLESPIE, IL 62033
(217) 839-2877
(217) 839-3233
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054002139
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2023083
PK
—
05
—
370647772001
—
IL
Enumeration date
12/12/2005
Last updated
02/09/2025
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