| NPI | 1205378742 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MACKENZIE HAHN Ncpdp Coordinator 479-636-9702 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: MD D0044709) |
| Enumeration Date | 2016-11-15 |
| Last Update Date | 2017-11-16 |