| NPI | 1467907741 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VADIM GOSHKO Owner 773-205-0106 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: IL 016004989) |
| Enumeration Date | 2016-08-17 |
| Last Update Date | 2018-12-19 |