| NPI | 1669525291 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN BOHMER Secretary 224-231-1833 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy, Long Term Care Pharmacy (Licence: IA 4548) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MN 264644) |
| 333600000X Pharmacy (Licence: WI 1705-43) | |
| 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: WY NR-51046) | |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2024-01-29 |