| NPI | 1306309067 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA DAWN GILLUM Owner Manager 606-393-5588 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2019-04-10 |
| Last Update Date | 2020-04-16 |