Provider Demographics
NPI:1447065487
Name:AGELESS RX SYSTEMS LLC
Entity type:Organization
Organization Name:AGELESS RX SYSTEMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:217-839-2877
Mailing Address - Street 1:103 N JERSEY ST STE 101
Mailing Address - Street 2:
Mailing Address - City:GILLESPIE
Mailing Address - State:IL
Mailing Address - Zip Code:62033-1403
Mailing Address - Country:US
Mailing Address - Phone:217-839-2877
Mailing Address - Fax:217-839-3233
Practice Address - Street 1:103 N JERSEY ST STE 101
Practice Address - Street 2:
Practice Address - City:GILLESPIE
Practice Address - State:IL
Practice Address - Zip Code:62033-1403
Practice Address - Country:US
Practice Address - Phone:217-839-2877
Practice Address - Fax:217-839-3233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-07
Last Update Date:2025-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy