| NPI | 1003943176 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN FISHER CROOK President, PIC 307-733-9768 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: WY 52-02356) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: WY 107114901) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2023-03-07 |