| NPI | 1063402345 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWIN JEROME MULDROW Pharmacist 773-762-5058 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: IL 054009146) |
| Additional Taxonomies | 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2008-06-12 |