| NPI | 1043227051 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRA L TAYLOR Manager 217-709-2351 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 333600000X Pharmacy (Licence: TX 15480) |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 3336C0003X Pharmacy, Community/Retail Pharmacy | |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2023-02-22 |