| NPI | 1285492496 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACOB EDWARDS Owner 620-845-6916 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy Long Term Care Pharmacy |
| Additional Taxonomies | 333600000X Pharmacy |
| 3336C0003X Pharmacy Community/Retail Pharmacy | |
| 3336C0004X Pharmacy Compounding Pharmacy | |
| 3336S0011X Pharmacy Specialty Pharmacy | |
| Enumeration Date | 2024-03-12 |
| Last Update Date | 2024-03-12 |