| NPI | 1477076578 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALYSSA SWEETEN Manager 217-709-2386 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 333600000X Pharmacy (Licence: AL 105067) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 3336C0003X Pharmacy Community/Retail Pharmacy | |
| Enumeration Date | 2017-07-20 |
| Last Update Date | 2018-04-26 |