| NPI | 1316021066 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRAD TROM CEO 505-727-1299 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: NM PH00001685) |
| Additional Taxonomies | 3336C0004X Pharmacy Compounding Pharmacy |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2014-03-19 |