| NPI | 1487997235 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD STEVEN KOSHAK Owner 262-641-2850 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0004X Pharmacy Compounding Pharmacy (Licence: WI 8543-042) |
| Enumeration Date | 2013-03-30 |
| Last Update Date | 2013-03-30 |