ILLINI PHARMACY SERVICES LLC (NPI# 1205146917) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205146917 |
| Entity Type | Organization |
| Organization Name | ILLINI PHARMACY SERVICES LLC |
| Other Organization Name | ILLINI PHARMACY SERVICES |
| Practice Address |
675 W Imboden Dr Decatur IL 62521-9068 |
| Practice Telephone | 2177916340 |
| Practice Fax Number | 2177916568 |
| Mailing Telephone | 2177916340 |
| Mailing Fax Number | 2177916568 |
| Enumeration Date | 2010-10-15 |
| Last Update Date | 2017-02-21 |
| Authorized Official Name | DARRIN SHASTEEN (OWNER) |
| Authorized Official Telephone | 2177916340 |
| Authorized Official Credential | BS PHARMACY |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 333600000X | Pharmacy | Suppliers | ||
| N | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers | ||
| Y | 3336L0003X |
Pharmacy Specialization: Long Term Care Pharmacy |
054.017565 | IL | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2127198 | 01 |
| Other Name | Type Code |
|---|---|
| Illini Pharmacy Services | Doing Business As Name - Organization |
| Street Address |
675 W IMBODEN DR |
| City | DECATUR |
| State | IL |
| Zip Code | 62521-9068 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053927988 | Caleb David Braasch | Pharmacist | 1818 South Airport Rd, Decatur, IL 62521 | 2020-09-16 |
| 1295390490 | Crossing Recovery Center | Substance Abuse Rehabilitation Facility | Crossing Recovery Center, 495 East Central Ave, Decatur, IL 62521 | 2019-05-03 |
| 1396300638 | Crossing Recovery Center | Substance Abuse Rehabilitation Facility | 495 E Central Ave, Decatur, IL 62521 | 2019-05-02 |
| 1679138911 | Crossing Recovery Center | Substance Abuse Rehabilitation Facility | 495 East Central Ave, Decatur, IL 62521 | 2019-05-02 |
| 1154848034 | Zack Shaw | Physical Therapist | 4855-57 East 36, Decatur, IL 62521 | 2017-08-23 |
| 1790032852 | Prashant Morolia | Family Medicine | 4775 E Maryland St, Decatur, IL 62521 | 2012-08-08 |
| 1003188913 | Evergreen Place Decatur, LLC | Assisted Living Facility | 4825 E Evergreen Court, Decatur, IL 62521 | 2012-02-08 |
| 1104133099 | Suzette Marie Shafer | Occupational Therapy Assistant | 1790 S. Fairview Ave., Decatur, IL 62521 | 2010-09-13 |
| 1467784090 | Community Health Improvement Center | Clinic/Center | 1221 East Condit Street, Decatur, IL 62521 | 2010-02-08 |
| 1982839056 | Kelly Clark Dds PC | Dentist | 3737 Us Rt 36 E, Decatur, IL 62521 | 2009-05-19 |
| Find all providers in zip 62521 | ||||
| Taxonomy Code | 3336L0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Long Term Care Pharmacy |
| A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities for mentally retarded, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871529560 | Enloe Drugs, LLC | Pharmacy | 796 N Sunnyside Rd, Decatur, IL 62522-1156 | 2006-06-24 |
| 1316410863 | Sand Drug Inc | Pharmacy | 1206 7th St Se, Decatur, AL 35601-3338 | 2019-01-08 |
| 1962504365 | Duncan Pharmacy Inc | Pharmacy | 2104 Danville Rd Sw, Decatur, AL 35601-4642 | 2006-09-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912512989 | Millenium Pharmacy Ltd | Pharmacy | 10604 Southwest Hwy Ste 102, Chicago Ridge, IL 60415-2704 | 2020-09-15 |
| 1992265235 | Illini Clinic Pharmacy Inc | Pharmacy | 211 S 1st Street, Alpha, IL 61413 | 2019-03-22 |
| 1750841342 | Illini Clinic Pharmacy Inc | Pharmacy | 855 Illini Dr Ste 200, Silvis, IL 61282-2904 | 2019-03-21 |
| 1679039358 | Remedi Seniorcare of Chicago, LLC | Pharmacy | 3600 Lacey Road, Suite 500, Downers Grove, IL 60515 | 2019-02-18 |
| 1720574676 | Critical Care Rx, LLC | Pharmacy | 126 Oak St, Peoria, IL 61602 | 2018-07-03 |
| 1538672449 | Wear Ltc | Pharmacy | 527 N Madison St Ste B, Carthage, IL 62321-1034 | 2017-11-14 |
| 1124546031 | Symbria Rx Services, LLC. | Pharmacy | 3200 Grant St Rm 41, Evanston, IL 60201-1903 | 2017-08-31 |
| 1699146720 | Pharmblue Illinois LLC | Pharmacy | 2960 Chartres St Ste 100, La Salle, IL 61301-1097 | 2015-10-15 |
| 1194144691 | Lifemed Illinois, LLC | Pharmacy | 881 Il Route 83, Bensenville, IL 60106-1219 | 2014-04-11 |
| 1205250412 | Becks Long Term Care Pharmacy Inc | Pharmacy | 1413 Locust Street, Eldorado, IL 62930 | 2014-02-07 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.