Organization
ILLINI PHARMACY SERVICES LLC
Active
Other names
Illini Pharmacy Services
Organization subpart
No
Provider details
NPI number
Authorized official
DARRIN SHASTEEN BS PHARMACY (OWNER)
(217) 791-6340
Entity
Organization
Contact information
Practice address
675 W IMBODEN DR, DECATUR, IL 62521-9068
(217) 791-6340
(217) 791-6568
Mailing address
675 W IMBODEN DR, DECATUR, IL 62521-9068
(217) 791-6340
(217) 791-6568
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
054.017565
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2127198
PK
—
Enumeration date
10/15/2010
Last updated
02/21/2017
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