NPI | 1023389434 |
---|---|
Doing Business As | ALLSTATE GOOD LIFE PHARMACY |
Entity Type | Organization |
Authorized Contact | TERRY FORREST Vice President 901-409-7091 |
Organization Subpart ? | No |
Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: IL 054017829) |
Additional Taxonomies | 333600000X Pharmacy |
Enumeration Date | 2012-01-16 |
Last Update Date | 2016-06-17 |