| NPI | 1013924059 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALAN T NIELSEN Treasurer 847-315-3523 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 333600000X Pharmacy (Licence: WI 7863) |
| Additional Taxonomies | 3336C0003X Pharmacy Community/Retail Pharmacy |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2015-11-26 |