| NPI | 1063572295 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN G. LIETHEN Secretary 952-205-6262 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: FL PH18603) |
| Additional Taxonomies | 3336M0003X Pharmacy Managed Care Organization Pharmacy |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2019-08-19 |