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 |