| NPI | 1316558851 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD MUSSHAFEN Pharmacist In Charge 769-231-1400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0004X Pharmacy, Compounding Pharmacy |
| Enumeration Date | 2020-08-10 |
| Last Update Date | 2021-12-13 |