| NPI | 1164968491 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC PETERS Owner 225-402-4084 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: LA PHY007413IR) |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2017-01-10 |
| Last Update Date | 2017-02-14 |