| NPI | 1578282729 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRA L TAYLOR Manager 217-709-2351 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 333600000X Pharmacy |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 3336C0003X Pharmacy Community/Retail Pharmacy | |
| 3336M0002X Pharmacy Mail Order Pharmacy | |
| Enumeration Date | 2022-08-23 |
| Last Update Date | 2023-08-23 |