| NPI | 1477568640 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRA L TAYLOR Manager 217-709-2351 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 333600000X Pharmacy (Licence: FL PHY0001866) |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2006-07-29 |
| Last Update Date | 2022-03-30 |