| NPI | 1154414928 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE WARREN Pharmacist 731-772-5238 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: TN 301) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2020-08-22 |