| NPI | 1154664191 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARED BENNETT Owner 918-406-6703 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: OK 29-6213) |
| Additional Taxonomies | 3336C0004X Pharmacy Compounding Pharmacy |
| 3336L0003X Pharmacy Long Term Care Pharmacy | |
| Enumeration Date | 2013-03-28 |
| Last Update Date | 2022-01-05 |