| NPI | 1215359518 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDON HAGEN General Manager 888-277-2132 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy Long Term Care Pharmacy |
| Additional Taxonomies | 333600000X Pharmacy |
| 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: CA 54470) | |
| 3336C0003X Pharmacy Community/Retail Pharmacy | |
| 3336C0004X Pharmacy Compounding Pharmacy | |
| Enumeration Date | 2014-01-06 |
| Last Update Date | 2022-07-07 |