| NPI | 1154661320 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATASHA GALLIZZI Pharm.D., PIC, Program Manager 307-635-1297 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: WY R10065) |
| Additional Taxonomies | 333600000X Pharmacy |
| 3336M0002X Pharmacy Mail Order Pharmacy | |
| Enumeration Date | 2013-02-25 |
| Last Update Date | 2019-04-12 |