NPI | 1669969531 |
---|---|
Entity Type | Organization |
Authorized Contact | MARK D EVARD VP Of Revenue Cycle 217-492-9651 |
Organization Subpart ? | Yes |
Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: IL 054.020399) |
Additional Taxonomies | 3336S0011X Pharmacy Specialty Pharmacy (Licence: IL 054.020399) |
Enumeration Date | 2018-04-17 |
Last Update Date | 2024-10-31 |