| NPI | 1043364870 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELAINE MOY Pharmacy Manager 618-826-4571 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy, Long Term Care Pharmacy |
| Additional Taxonomies | 283Q00000X Psychiatric Hospital (Licence: IL 059007736) |
| 3336I0012X Pharmacy, Institutional Pharmacy | |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2019-07-02 |