Registry details
Type
Individual
Primary specialty
Pharmacist
Enumerated
Nov 2, 2020
License(s)
051294006 (IL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 2080 N STATE ROUTE 50 | Bourbonnais, IL 60914-4410 | |
| LOCATION | 2080 N STATE ROUTE 50 | Bourbonnais, IL 60914-4410 | 815-937-5175 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.