| NPI | 1093866030 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARA RATCLIFF Pharmacist In Charge 318-376-4530 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2019-09-13 |