Organization
ZZZ
Active
Organization
ZZZ
Active
Other names
zzz
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WALTER SHARSHON (OWNER)
(630) 210-5307
Entity
Organization
Contact information
Practice address
402 PINE ST, DELAVAN, IL 61734-7575
(309) 244-7115
(309) 244-7151
Mailing address
931 W GALENA BLVD, AURORA, IL 60506-3751
(309) 244-7115
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
3423423423
AL
Other
Enumeration date
05/17/2016
Last updated
05/17/2016
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