| NPI | 1144362567 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHAD J KODIAK Owner 815-725-9315 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: IL 054-004174) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: IL 054-004174) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2022-09-20 |