| NPI | 1114933785 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRA L TAYLOR Manager 217-709-2351 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 333600000X Pharmacy (Licence: CA PHY45693) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 3336C0003X Pharmacy Community/Retail Pharmacy | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2022-05-10 |