| NPI | 1447963061 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA KIM VILT CFO 815-450-7754 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Additional Taxonomies | 3336S0011X Pharmacy Specialty Pharmacy |
| Enumeration Date | 2022-12-28 |
| Last Update Date | 2022-12-28 |