NPIMap

Organization Active NPI

Illini Clinic Pharmacy Inc

Doing business as Alwood Pharmacy

  • Community/Retail Pharmacy
  • Alpha, IL
National Provider Identifier
1053838458
Registry record updated Jul 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
054020443 Issued in IL
Legal business name
ILLINI CLINIC PHARMACY INC
Doing business as
Alwood Pharmacy
Practice address
211 S. 1St St
Alpha, IL 61413-0355
Phone
(309) 629-4506
Fax
(309) 629-2611
NPI assigned
Aug 25, 2017
Last updated
Jul 1, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Donna MeridethNPI 1023604758
Title
Owner/Pic
Phone
(309) 629-4506

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 054020443 IL Primary

Addresses

Primary practice location

211 S. 1St St
Alpha, IL 61413-0355

Mailing address

PO Box 355
Alpha, IL 61413-0355
Phone (309) 629-4506

Other identifiers 1

IdentifierTypeStateIssuer
2169798OtherPK

Other names 1

  • Alwood Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20171206002871 IL DME Supplier - Pharmacy 1355355884 Practice locations: Alpha, IL
O20181012000121 IL Part B Supplier - Mass Immunization (Roster Biller Only) 1355355884 Practice locations: Alpha, IL

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Illini Clinic Pharmacy Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1503619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593561600000",
    "number": "1053838458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 355",
            "city": "ALPHA",
            "state": "IL",
            "postal_code": "614130355",
            "telephone_number": "309-629-4506",
            "fax_number": "309-629-2611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 S. 1ST ST",
            "city": "ALPHA",
            "state": "IL",
            "postal_code": "614130355",
            "telephone_number": "309-629-4506",
            "fax_number": "309-629-2611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINI CLINIC PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-25",
        "last_updated": "2020-07-01",
        "certification_date": "2020-07-01",
        "status": "A",
        "authorized_official_last_name": "MERIDETH",
        "authorized_official_first_name": "DONNA",
        "authorized_official_title_or_position": "OWNER/PIC",
        "authorized_official_telephone_number": "309-629-4506"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054020443",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2169798",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Alwood Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Alpha, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.