Provider Demographics
NPI:1063446524
Name:RESPIRATORY UNIT DOSE PHARMACY INC.
Entity Type:Organization
Organization Name:RESPIRATORY UNIT DOSE PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER, CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:H
Authorized Official - Last Name:RICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:RCP
Authorized Official - Phone:309-693-3013
Mailing Address - Street 1:5016 N UNIVERSITY ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-4781
Mailing Address - Country:US
Mailing Address - Phone:309-693-3013
Mailing Address - Fax:309-693-3271
Practice Address - Street 1:5016 N UNIVERSITY ST
Practice Address - Street 2:SUITE 107
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-4781
Practice Address - Country:US
Practice Address - Phone:309-693-3013
Practice Address - Fax:309-693-3271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL0619910001Medicare ID - Type Unspecified