| NPI | 1194919597 |
|---|---|
| Doing Business As | ELECTRIC BOAT PHARMACY |
| Entity Type | Organization |
| Authorized Contact | KIRA TAYLOR Manager 217-709-2351 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 333600000X Pharmacy (Licence: RI PHA00506) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 3336M0003X Pharmacy, Managed Care Organization Pharmacy | |
| Enumeration Date | 2007-08-29 |
| Last Update Date | 2022-05-06 |