| NPI | 1194127639 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLEN GEGENHEIMER Owener 985-792-4377 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: LA 006951) |
| Enumeration Date | 2014-09-16 |
| Last Update Date | 2014-09-16 |