| NPI | 1407144777 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFF BARTON Owner 219-465-2181 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0004X Pharmacy Compounding Pharmacy (Licence: IL 054019539) |
| Additional Taxonomies | 3336C0003X Pharmacy Community/Retail Pharmacy |
| 333600000X Pharmacy (Licence: IN 60006264A) | |
| 3336S0011X Pharmacy Specialty Pharmacy | |
| Enumeration Date | 2011-07-20 |
| Last Update Date | 2017-03-17 |