| NPI | 1104920164 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONNIE HILL Owner 841-367-2149 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: OR RP0000556CS) |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2020-08-22 |