| NPI | 1194680330 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA LAUREN SCHULTZ Pharmacist In Charge 877-389-9040 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| 3336S0011X Pharmacy, Specialty Pharmacy | |
| Enumeration Date | 2025-12-19 |
| Last Update Date | 2025-12-19 |