Organization
MEDGENYX, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THERESA JOHNSON RPH (CEO)
(217) 778-8505
Entity
Organization
Contact information
Practice address
1734 S STONE CREEK BLVD, URBANA, IL 61802-9667
(217) 390-0273
Mailing address
907 W MARKETVIEW DR STE 10, CHAMPAIGN, IL 61822-1250
(217) 778-8505
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
—
—
Other
Enumeration date
05/01/2023
Last updated
06/01/2023
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