| NPI | 1366062671 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW SHELDON CARPENTER Owner/Pharmacy Manager 681-213-1133 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2020-04-16 |
| Last Update Date | 2025-10-13 |