| NPI | 1376061309 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALYSSA SWEETEN Manager 217-709-2386 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 333600000X Pharmacy |
| Additional Taxonomies | 3336C0003X Pharmacy Community/Retail Pharmacy |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2017-08-30 |
| Last Update Date | 2018-08-28 |