| NPI | 1205037637 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRA L TAYLOR Manager 217-709-2351 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Additional Taxonomies | 333600000X Pharmacy (Licence: CO PDO-694) |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2023-10-30 |