| NPI | 1053702662 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD ORTIZ Practice & Compliance Administrator 630-372-1100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: IL 036064932) |
| Enumeration Date | 2015-02-18 |
| Last Update Date | 2023-09-08 |