| NPI | 1114027414 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMIE MISKIMINS Manager, Pharmacy Licensing/Contrac 817-572-0009 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: TX 30016) |
| Additional Taxonomies | 3336C0004X Pharmacy Compounding Pharmacy |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2015-10-19 |