| NPI | 1265825830 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH DOUGLAS CEO 815-404-4871 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy, Long Term Care Pharmacy (Licence: GA PHRE010142) |
| Additional Taxonomies | 333600000X Pharmacy |
| 3336C0003X Pharmacy, Community/Retail Pharmacy | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2015-03-06 |
| Last Update Date | 2022-09-15 |