| NPI | 1255387627 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIONA TOWNSEND Asst Manager Plan Implementation 847-916-4513 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: UT 8600197-1703) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 333600000X Pharmacy | |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2013-09-09 |