| NPI | 1225059207 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SEAN LYSINGER VP 502-580-2376 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: FL PH26577) |
| Additional Taxonomies | 3336C0002X Pharmacy Clinic Pharmacy |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2025-06-12 |