Healthcare Provider Details

I. General information

NPI: 1679131064
Provider Name (Legal Business Name): PAIGE KRISTINE MEADE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAIGE KRISTINE CROMER

II. Dates (important events)

Enumeration Date: 05/31/2019
Last Update Date: 05/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 E MAIN ST BLDG 982053
DANVILLE IL
61832-5100
US

IV. Provider business mailing address

116 W PENNSYLVANIA AVE
URBANA IL
61801-5033
US

V. Phone/Fax

Practice location:
  • Phone: 217-665-4183
  • Fax:
Mailing address:
  • Phone: 317-646-7822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number051301386
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: