| NPI | 1023199684 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL ROGER CHAMBERLAIN Owner PIC 985-875-9906 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: LA C004842-IR) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2020-08-22 |