| NPI | 1265703128 |
|---|---|
| Former Name | DETRA ELAINE WOOTEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA Rph18214) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 8706) |
| 183500000X Pharmacist (Licence: TX 32754) | |
| Enumeration Date | 2012-01-24 |
| Last Update Date | 2012-01-24 |