| NPI | 1235585571 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN BOHMER Secretary 224-231-1833 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy, Long Term Care Pharmacy (Licence: WA Y006882) |
| Additional Taxonomies | 333600000X Pharmacy |
| 3336C0003X Pharmacy, Community/Retail Pharmacy | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2016-05-05 |
| Last Update Date | 2024-01-29 |