| NPI | 1104861764 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN BOHMER Secretary 224-231-1833 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy, Long Term Care Pharmacy (Licence: FL PH21681) |
| Additional Taxonomies | 333600000X Pharmacy (Licence: FL PH21681) |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: FL PH21681) | |
| Enumeration Date | 2006-06-18 |
| Last Update Date | 2023-03-08 |