| NPI | 1164891420 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM ROBERTSON Pharmacist 318-445-7815 |
| Organization Subpart ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: LA 11900) |
| Additional Taxonomies | 251K00000X Public Health or Welfare (Licence: LA 11900) |
| Enumeration Date | 2015-09-16 |
| Last Update Date | 2015-09-16 |