| NPI | 1376560482 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATT MCMULLIN Director Of Healthcare Contracting 479-371-8711 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: VA 0201003677) |
| Additional Taxonomies | 333600000X Pharmacy |
| 3336S0011X Pharmacy Specialty Pharmacy | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2024-06-25 |