| NPI | 1083796874 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IRIWA SHAGABAEV Srp 817-838-6558 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: NY 027375) |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2020-08-22 |