| 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 |