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Individual

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Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
901 MACARTHUR BLVD, MUNSTER, IN 46321-2901
(219) 836-7031
Mailing address
901 MACARTHUR BLVD, MUNSTER, IN 46321-2901
(219) 836-7031

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
26019233A
IN

Other

Enumeration date
01/04/2018
Last updated
01/04/2018
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