Individual
JIM HOME
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
296 E DEERPATH, LAKE FOREST, IL 60045-1940
(847) 234-2413
(847) 234-7921
Mailing address
296 E DEERPATH, LAKE FOREST, IL 60045-1940
(847) 234-2413
(847) 234-7921
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051299848
IL
Other
Enumeration date
08/12/2020
Last updated
08/12/2020
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