| NPI | 1104965003 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY ODOM CEO 307-754-1179 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336I0012X Pharmacy, Institutional Pharmacy (Licence: WY 5201342) |
| Additional Taxonomies | 3336L0003X Pharmacy, Long Term Care Pharmacy (Licence: WY 5201342) |
| 3336C0003X Pharmacy, Community/Retail Pharmacy | |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2023-03-07 |