| NPI | 1811248412 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN BOHMER Secretary 224-231-1833 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy, Long Term Care Pharmacy (Licence: GA PHNR000904) |
| Additional Taxonomies | 3336L0003X Pharmacy, Long Term Care Pharmacy (Licence: SC 15708) |
| 3336L0003X Pharmacy, Long Term Care Pharmacy (Licence: NC 12588) | |
| Enumeration Date | 2012-09-24 |
| Last Update Date | 2024-01-17 |