| NPI | 1932845948 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OSVALDO WESLY Medical Director 217-414-1041 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Additional Taxonomies | 3336S0011X Pharmacy Specialty Pharmacy |
| Enumeration Date | 2022-05-11 |
| Last Update Date | 2025-04-07 |