| NPI | 1154893600 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN EUGENE BURR Secretary 712-310-4701 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336M0002X Pharmacy, Mail Order Pharmacy |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2018-12-21 |
| Last Update Date | 2024-02-14 |