| NPI | 1497968945 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VIVEK IYENGAR Owner 708-444-8300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: IL 042618383) |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2021-12-07 |