| NPI | 1144571266 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER PONCE Manager 847-527-2489 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 333600000X Pharmacy (Licence: TX 28301) |
| Additional Taxonomies | 3336C0003X Pharmacy Community/Retail Pharmacy |
| 291U00000X Clinical Medical Laboratory | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2012-09-28 |
| Last Update Date | 2024-10-10 |