| NPI | 1033172119 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNA MAE GRIDER Owner 270-866-6477 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: KY P00682) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: P00682) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2008-03-05 |