| NPI | 1225321441 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LILLIAN D LOCKETT Managing Executive 979-299-3255 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: TX J1463) |
| Enumeration Date | 2011-05-20 |
| Last Update Date | 2011-05-20 |