| NPI | 1356560742 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRAIG ANDREW FREDERICK Pharmacist In Charge 307-836-9270 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: WY 5282214) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2020-08-22 |