| NPI | 1104852979 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARSHA WESLEY Pharmacy Supervisor 1810-257-9827 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: MI 5301005764) |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2020-08-22 |