| NPI | 1679626550 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARA TIMMONS Pharmacy Mgr 618-532-1811 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy, Long Term Care Pharmacy (Licence: IL 054017317) |
| Additional Taxonomies | 282E00000X (Licence: IL 059005407) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2018-12-19 |