| NPI | 1205974185 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALAN T NIELSEN Treasurer 847-315-3523 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 333600000X Pharmacy |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 3336C0003X Pharmacy Community/Retail Pharmacy | |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2016-01-06 |