| NPI | 1700486701 |
|---|---|
| Former Name | WENDY LYNN ILLICH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SD R-6553) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 116769) |
| Enumeration Date | 2020-10-28 |
| Last Update Date | 2020-10-28 |