Organization
BOARD OF TRUSTEES FOR EASTERN ILLINOIS UNIVERSITY
Active
Other names
EASTERN IL UNIVERSITY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
AMY MALMEN RPH (PHARM SUPV)
(217) 581-7779
Entity
Organization
Contact information
Practice address
1102 HUMAN SERVICES BUILDING, 600 LINCOLN AVE, CHARLESTON, IL 61920
(217) 581-7779
(217) 581-7780
Mailing address
1102 HUMAN SERVICES BUILDING, 600 LINCOLN AVE, CHARLESTON, IL 61920
(217) 581-7779
(217) 581-7780
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
Primary
054017107
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2018991
PK
—
Enumeration date
10/23/2006
Last updated
03/01/2017
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