| NPI | 1194893214 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDALL A COX Pharmacy Manager 765-529-9600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: IN 60005600A) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2023-03-07 |