| NPI | 1316960453 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARTIN GRAVIL Pharmacist 270-739-0303 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: KY P06320) |
| Additional Taxonomies | 3336L0003X Pharmacy, Long Term Care Pharmacy |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: KY P06320) | |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2022-03-16 |