| NPI | 1043225238 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALAN T NIELSEN Treasurer 847-315-3523 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 333600000X Pharmacy (Licence: MA 1876) |
| Additional Taxonomies | 3336C0003X Pharmacy Community/Retail Pharmacy |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2006-07-29 |
| Last Update Date | 2016-07-21 |