| NPI | 1003995788 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TOM ALLEN MAERTENS Owner/Pharmacist In Charge 307-684-7003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: WY 5200112) |
| Additional Taxonomies | 333600000X Pharmacy |
| 3336L0003X Pharmacy Long Term Care Pharmacy | |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2018-10-22 |