| NPI | 1669066395 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY JANE DERICK Sole Owner 847-381-8899 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2021-02-23 |
| Last Update Date | 2022-09-09 |