| NPI | 1053789065 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HIEDI MASON Pharmacist 870-820-1413 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251K00000X Public Health or Welfare (Licence: AR PD12269) |
| Enumeration Date | 2015-09-08 |
| Last Update Date | 2015-09-08 |