| NPI | 1720574676 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAM ENLOE Member 618-339-4211 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy, Long Term Care Pharmacy (Licence: IL 54-020902) |
| Enumeration Date | 2018-07-03 |
| Last Update Date | 2021-11-22 |