| NPI | 1114309465 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALTAMASH KHAN Store Manager 224-619-9786 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: IL 054.019391) |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2015-06-23 |
| Last Update Date | 2018-04-19 |