| NPI | 1316695414 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRA L TAYLOR Manager 217-709-2351 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 333600000X Pharmacy |
| Additional Taxonomies | 3336C0003X Pharmacy Community/Retail Pharmacy |
| 3336M0002X Pharmacy Mail Order Pharmacy | |
| Enumeration Date | 2022-03-17 |
| Last Update Date | 2022-04-08 |