| NPI | 1942453576 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER PONCE Manager 847-527-2489 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 333600000X Pharmacy (Licence: CO 753) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 3336C0002X Pharmacy Clinic Pharmacy | |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2025-08-06 |