| NPI | 1922066414 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN BOHMER Secretary 224-231-1833 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy Long Term Care Pharmacy (Licence: WA PHAR.CF.60544033) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 333600000X Pharmacy | |
| 3336C0003X Pharmacy Community/Retail Pharmacy | |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2024-01-18 |