| NPI | 1114041134 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WALTER BRENT PEARSON Manager 318-445-1488 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: LA 870RC) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2020-08-22 |