Organization
ILLINOIS STATE UNIVERSITY
Active
Other names
ISU Student Health Service Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MARIE RUPERT PHARMD (PHARMACIST IN CHARGE)
(309) 438-8713
Entity
Organization
Contact information
Practice address
201 N. UNIVERSITY ST, NORMAL, IL 61790
(309) 438-8713
(309) 438-7569
Mailing address
201 N. UNIVERSITY ST, NORMAL, IL 61790
(309) 438-8713
(309) 438-7569
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054017028
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1999303700
—
IL
01
—
2021237
PK
—
Enumeration date
12/08/2006
Last updated
03/23/2021
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