| NPI | 1487717898 |
|---|---|
| Former Legal Business Name | 1ST AVENUE PHARMACY INC. |
| Entity Type | Organization |
| Authorized Contact | KAREN BOHMER Secretary 224-231-1833 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy Long Term Care Pharmacy |
| Additional Taxonomies | 3336C0002X Pharmacy Clinic Pharmacy |
| 3336S0011X Pharmacy Specialty Pharmacy | |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2024-05-21 |