NPI | 1114156403 |
---|---|
Entity Type | Organization |
Authorized Contact | DONNA SHOFE Member, Manager 731-554-9872 |
Organization Subpart ? | No |
Primary Taxonomy | 3336L0003X Pharmacy, Long Term Care Pharmacy |
Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: TN 4669) |
Enumeration Date | 2009-07-07 |
Last Update Date | 2019-01-04 |