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Contact Information

ILLINOIS STATE UNIVERSITY
201 N. UNIVERSITY ST
NORMAL, IL61790
 Phone: 309-438-8713
 Fax: 309-438-7569
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
 

Pharmacy

333600000X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for ILLINOIS STATE UNIVERSITY

NPI Number 1952460388
LBN Legal business name ILLINOIS STATE UNIVERSITY
Authorized official MARIE RUPERT - (PHARMACIST IN CHARGE)
Entity Organization
Organization subpart 1 No
Enumeration date 12/08/2006
Last updated 03/23/2021 - About 5 years ago
Identifiers
IL License # 054017028
IL Medicaid 1999303700
Other 2021237 PK
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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