| NPI | 1720132566 |
|---|---|
| Other Name | ILLINOIS DEPARTMENT OF HUMAN SERVICES |
| Entity Type | Organization |
| Authorized Contact | RAYMOND GLENN VARNUM Pharmacy Manager 618-474-3408 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy, Long Term Care Pharmacy |
| Additional Taxonomies | 283Q00000X Psychiatric Hospital (Licence: IL 059.007697) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2022-11-29 |