| NPI | 1306195615 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THAI PHAM Officer 817-642-5613 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: TX 28125) |
| Enumeration Date | 2012-08-31 |
| Last Update Date | 2017-01-06 |