| NPI | 1255362737 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ADRIENNE MIGNON KLINGSMITH PIC 660-385-2167 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 3336L0003X Pharmacy, Long Term Care Pharmacy |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2020-05-20 |