| NPI | 1013979640 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREG GRIDER Manager 270-866-7541 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: KY P06731) |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: KY P06731) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2012-10-10 |