| NPI | 1225528672 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MEAGAN ELLESSE JACOBS PIC 210-404-4538 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: TX 31911) |
| Enumeration Date | 2018-05-11 |
| Last Update Date | 2018-05-11 |