Organization
AGELESS RX SYSTEMS LLC
Active
Other names
Sullivans Drugs of Mt. Olive
Organization subpart
No
Provider details
NPI number
Authorized official
TERRY ALLAN PHARM.D (OWNER)
(217) 839-2877
Entity
Organization
Contact information
Practice address
107 E MAIN ST STE D, MOUNT OLIVE, IL 62069-1703
(217) 999-3016
(217) 999-3020
Mailing address
103 N JERSEY ST STE 101, GILLESPIE, IL 62033-1403
(217) 839-2877
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054003991
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2023241
PK
—
05
—
370647772002
—
IL
Enumeration date
12/14/2005
Last updated
06/07/2024
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