| NPI | 1144761859 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MACKENZIE HAHN Ncpdp 479-636-9702 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: NV 14699) |
| Enumeration Date | 2017-03-14 |
| Last Update Date | 2017-11-15 |