| NPI | 1477712503 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRA TAYLOR Manager 217-709-2351 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 333600000X Pharmacy |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: NY 029196) | |
| Enumeration Date | 2008-06-04 |
| Last Update Date | 2023-11-07 |