| NPI | 1063815470 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAMILLA FROST Owner, PIC 865-560-0135 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: TN 5455) |
| Additional Taxonomies | 3336M0002X Pharmacy, Mail Order Pharmacy |
| 3336S0011X Pharmacy, Specialty Pharmacy | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 333600000X Pharmacy | |
| 3336C0004X Pharmacy, Compounding Pharmacy | |
| Enumeration Date | 2014-09-30 |
| Last Update Date | 2021-01-07 |