| NPI | 1083606420 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELE E WOODBURY Certified Pharmacy Technician 304-634-1571 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: WY 5200275) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2020-08-22 |