| NPI | 1114964541 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORENZO TORRES New Store Enrollments 847-916-4463 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: CA PHY39238) |
| Additional Taxonomies | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2020-08-22 |