| NPI | 1528875036 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER PONCE Manager 224-475-5702 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 333600000X Pharmacy |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 3336C0003X Pharmacy Community/Retail Pharmacy | |
| Enumeration Date | 2024-12-17 |
| Last Update Date | 2024-12-17 |