| NPI | 1205847886 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE CLARK PIC 817-394-2318 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: TX 24399) |
| Additional Taxonomies | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2020-08-22 |