| NPI | 1205998614 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUDY WELCH Pharmacy Manager 866-289-6337 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: TX 24171) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2020-08-22 |