| NPI | 1245357706 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KASSIE LYNN VILLA Pharmacy Manager 928-377-1350 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy, Long Term Care Pharmacy |
| Additional Taxonomies | 3336C0002X Pharmacy, Clinic Pharmacy (Licence: AZ 4696) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2020-03-11 |