| NPI | 1275101164 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDY NEISWONGER Interim President 708-915-6111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336H0001X Pharmacy, Home Infusion Therapy Pharmacy |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2021-06-16 |
| Last Update Date | 2021-06-16 |