| NPI | 1538174610 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER PONCE Manager 847-527-2489 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 333600000X Pharmacy (Licence: TX 23205) |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 3336C0003X Pharmacy Community/Retail Pharmacy | |
| Enumeration Date | 2006-07-29 |
| Last Update Date | 2025-08-01 |