| NPI | 1134223357 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANA JOHNSON Program Supervisor Vi 512-438-3124 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy Long Term Care Pharmacy |
| Additional Taxonomies | 3336I0012X Pharmacy Institutional Pharmacy |
| Enumeration Date | 2006-09-08 |
| Last Update Date | 2019-07-31 |