| NPI | 1639253776 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRA TAYLOR Manager 217-709-2351 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: OK 24825) |
| 333600000X Pharmacy (Licence: OK 23137) | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2022-05-02 |