| NPI | 1144497603 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRA TAYLOR Manager 217-709-2351 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 333600000X Pharmacy (Licence: WY R10056) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2008-05-14 |
| Last Update Date | 2022-04-12 |