| NPI | 1114563319 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHANIEL ADAMS Pharmacist 270-370-0005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy |
| Additional Taxonomies | 3336S0011X Pharmacy, Specialty Pharmacy |
| Enumeration Date | 2019-11-22 |
| Last Update Date | 2021-01-05 |