| NPI | 1477568483 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALAN T. NIELSEN Treasurer 847-315-3523 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 333600000X Pharmacy (Licence: TX 11190) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 3336C0003X Pharmacy Community/Retail Pharmacy | |
| Enumeration Date | 2006-07-29 |
| Last Update Date | 2016-11-17 |