| NPI | 1114095320 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GORDON JOHN MAZZOTTI President Chief Executive Officer 217-824-3533 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: IL 054005099) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2010-12-14 |