| NPI | 1285268391 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY S. MCLELLAND Credentialing Contractor 405-590-1637 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2020-02-27 |
| Last Update Date | 2020-02-27 |