Individual
LAUREL PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2014 N MICHIGAN ST, PLYMOUTH, IN 46563-1048
(574) 936-8388
(574) 936-7807
Mailing address
2014 N MICHIGAN ST, PLYMOUTH, IN 46563-1048
(574) 936-8388
(574) 936-7807
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
051.297002
IL
183500000X
Pharmacist
Primary
26025359A
IN
Other
Enumeration date
09/27/2014
Last updated
09/27/2014
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