| NPI | 1164703203 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARED COLLETTE Pharmacist 316-218-0818 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: KS ks1-14452) |
| Additional Taxonomies | 3336C0004X Pharmacy, Compounding Pharmacy (Licence: KS ks1-14452) |
| Enumeration Date | 2011-09-02 |
| Last Update Date | 2011-09-02 |