| NPI | 1194356667 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA MAWUENYEGA Owner/Manager 314-607-2603 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory |
| Enumeration Date | 2020-02-03 |
| Last Update Date | 2022-03-28 |