| NPI | 1790146157 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER PONCE Manager 847-527-2489 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 333600000X Pharmacy (Licence: NY 034737) |
| Additional Taxonomies | 3336C0004X Pharmacy Compounding Pharmacy |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 3336C0003X Pharmacy Community/Retail Pharmacy | |
| Enumeration Date | 2016-03-14 |
| Last Update Date | 2025-08-11 |