| NPI | 1629219290 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN BOHMER Secretary 224-231-1833 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336S0011X Pharmacy, Specialty Pharmacy (Licence: NV PH02558) |
| Additional Taxonomies | 3336C0004X Pharmacy, Compounding Pharmacy (Licence: NV PH02558) |
| 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: NV PH02558) | |
| Enumeration Date | 2009-03-11 |
| Last Update Date | 2024-01-23 |