| NPI | 1003557075 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN RALPH SHELTON Pharmacist In Charge 318-628-3575 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy, Long Term Care Pharmacy |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2022-04-05 |