| NPI | 1851362230 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | QUIN HOSTETLER Manager 217-789-4355 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: IL 054013750) |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2008-04-20 |