Ageless RX Systems LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

054003991 Issued in IL

Legal business name

AGELESS RX SYSTEMS LLC

Doing business as

Sullivans Drugs of Mt. Olive

Practice address

107 E Main St Ste D
Mount Olive, IL 62069-1703

Phone

(217) 999-3016

Fax

(217) 999-3020

NPI assigned

Dec 14, 2005

Last updated

Jun 7, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Terry Allan, PHARM.D

Title

Owner

Phone

(217) 839-2877

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Sullivans Drugs of Mt. Olive Doing business as

Tax ID family

Ageless RX Systems LLC4 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.

• Ageless RX Systems LLC

  dba Sulivan Drugs of Gillespie

  • Community/Retail Pharmacy
  • Gillespie, IL
  • NPI 1134104219
  NPD tax ID
• Ageless RX Systems LLC

  dba Sullivans Drugs of Bunker Hill

  • Community/Retail Pharmacy
  • Bunker Hill, IL
  • NPI 1164374542
  NPD tax ID
• Ageless RX Systems LLC

  dba Sullivans Drugs LTC

  • Long Term Care Pharmacy
  • Gillespie, IL
  • NPI 1447065487
  NPD tax ID

Locations

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.

• Harry Michael Zollars, PHARMD

  • Pharmacist
  • Maryville, IL
  • NPI 1679989503
  NPD (past)

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

{
    "created_epoch": "1134518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717718400000",
    "number": "1871578583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 N JERSEY ST STE 101",
            "city": "GILLESPIE",
            "state": "IL",
            "postal_code": "620331403",
            "telephone_number": "217-839-2877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 E MAIN ST STE D",
            "city": "MOUNT OLIVE",
            "state": "IL",
            "postal_code": "620691703",
            "telephone_number": "217-999-3016",
            "fax_number": "217-999-3020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGELESS RX SYSTEMS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-14",
        "last_updated": "2024-06-07",
        "certification_date": "2024-06-07",
        "status": "A",
        "authorized_official_last_name": "ALLAN",
        "authorized_official_first_name": "TERRY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "217-839-2877",
        "authorized_official_credential": "PHARM.D"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054003991",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "370647772002",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2023241",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sullivans Drugs of Mt. Olive",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Advanced Family Dental & Orthodontics of Mt. Olive, P.C.
• Cindy Lee Bertolino, NP
• Brooke A Borrowman
• Catherine A Brister, MSOT
• Dennis J. Guardia, DMD
• Brandi Lynn Kelly, LCSW

• Community/Retail Pharmacy in Mount Olive, IL
• Providers in Mount Olive, IL by specialty
• Community/Retail Pharmacy in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.