| NPI | 1194245837 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAYE WALLER Accounting Manager 318-412-0349 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: LA PHY.007500-IR) |
| Enumeration Date | 2017-06-23 |
| Last Update Date | 2017-06-23 |