| NPI | 1508380080 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRA TAYLOR Manager 217-709-2351 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 333600000X Pharmacy (Licence: GA PHRE010528) |
| Additional Taxonomies | 3336C0003X Pharmacy Community/Retail Pharmacy |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2017-07-27 |
| Last Update Date | 2022-05-10 |