| NPI | 1306182175 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY WHOBREY Provider Enrollment 502-630-7249 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy, Long Term Care Pharmacy |
| Enumeration Date | 2012-12-22 |
| Last Update Date | 2020-01-22 |