| NPI | 1104107796 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SEAN FALSEY Pharmacy Supervisor 815-397-1587 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: IL 051292971) |
| Enumeration Date | 2011-09-08 |
| Last Update Date | 2011-09-08 |