| NPI | 1295241867 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY JOANNA TILLEY PIC/Owner 918-865-7400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 333600000X Pharmacy (Licence: OK 11-8083) |
| Enumeration Date | 2017-12-19 |
| Last Update Date | 2021-12-07 |