| NPI | 1992710057 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VIRGINIA GARZA Manager 217-709-2364 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 333600000X Pharmacy (Licence: WI 7859) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 3336C0003X Pharmacy Community/Retail Pharmacy | |
| Enumeration Date | 2006-07-29 |
| Last Update Date | 2024-06-14 |