| NPI | 1972748226 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER PONCE Manager 847-527-2489 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336C0002X Pharmacy Clinic Pharmacy |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 333600000X Pharmacy (Licence: MO 2009007931) | |
| Enumeration Date | 2008-12-15 |
| Last Update Date | 2024-11-06 |