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General NPI Number Information
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NPI Number | 1619774296
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Entity Type | Organization
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Legal Business Name | ILLINOIS PHARMACISTS MANAGEMENT ENTERPRISES, LLC
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Dates
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Enumeration Date | 02/28/2025
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Last Update Date | 02/28/2025
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Provider Practice Location Address
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Address Line | 204 W COOK ST
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City | SPRINGFIELD
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State | IL
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Zip | 62704-2526
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Country | US
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Telephone | 217-522-7300
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Fax | 217-522-7349
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Provider Business Mailing Address
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Address Line | 204 W COOK ST
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City | SPRINGFIELD
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State | IL
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Zip | 62704-2526
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Country | US
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Telephone | 217-522-7300
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Fax | 217-522-7349
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | GARTH REYNOLDS
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Credential | BSPHARM, RPH
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Telephone | 217-522-7300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number |
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License Number State |
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