NPIMap

Organization Active NPI

Illini Clinic Pharmacy Inc

  • Community/Retail Pharmacy
  • Silvis, IL
National Provider Identifier
1356561039
Registry record updated Jul 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
054013807 Issued in IL
Legal business name
ILLINI CLINIC PHARMACY INC
Practice address
855 Illini Dr
Suite 200
Silvis, IL 61282-2907
Phone
(309) 792-7002
Fax
(309) 792-7003
NPI assigned
Apr 26, 2007
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
Mr. Jeffrey R Merideth, RPH
Title
President
Phone
(309) 792-7002

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 054013807 IL Primary
Long Term Care Pharmacy 3336L0003X NU

Addresses

Primary practice location

855 Illini Dr
Suite 200
Silvis, IL 61282-2907

Mailing address

855 Illini Dr
Suite 200
Silvis, IL 61282-2907
Phone (309) 792-7002

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060203000231 IL Part B Supplier - Mass Immunization (Roster Biller Only) 1355355884 Practice locations: Silvis, 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

NPI Registry JSON

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

{
    "created_epoch": "1177545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593561600000",
    "number": "1356561039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "855 ILLINI DR",
            "address_2": "SUITE 200",
            "city": "SILVIS",
            "state": "IL",
            "postal_code": "612822907",
            "telephone_number": "309-792-7002",
            "fax_number": "309-792-7003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "855 ILLINI DR",
            "address_2": "SUITE 200",
            "city": "SILVIS",
            "state": "IL",
            "postal_code": "612822907",
            "telephone_number": "309-792-7002",
            "fax_number": "309-792-7003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINI CLINIC PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-26",
        "last_updated": "2020-07-01",
        "certification_date": "2020-07-01",
        "status": "A",
        "authorized_official_last_name": "MERIDETH",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "309-792-7002",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054013807",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Silvis, 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.