| NPI | 1275754798 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT LUCKOW Owner/Manager 877-629-4446 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: IL 54020427) |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: IL 054002067) |
| 3336C0003X Pharmacy, Community/Retail Pharmacy | |
| 3336C0004X Pharmacy, Compounding Pharmacy | |
| 3336H0001X Pharmacy, Home Infusion Therapy Pharmacy (Licence: IL 54020427) | |
| 3336S0011X Pharmacy, Specialty Pharmacy (Licence: IL 54020427) | |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2018-03-14 |