| NPI | 1104234095 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFERY PRICE Pharmacist 870-633-7474 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2014-07-24 |
| Last Update Date | 2014-07-24 |