| NPI | 1043232044 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY MUELLER Pharmacy Manager 618-463-7425 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336M0002X Pharmacy, Mail Order Pharmacy (Licence: IL 093013441) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2020-08-22 |