| NPI | 1114113602 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLEN COREY PIERSON Pharmacist 360-704-7575 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: WA CF59039) |
| Enumeration Date | 2007-09-19 |
| Last Update Date | 2007-09-19 |