NPI | 1396015103 |
---|---|
Entity Type | Organization |
Authorized Contact | ERICA SULLIVAN DITTA Owner/Pharmacist In Charge 318-355-3202 |
Organization Subpart ? | No |
Primary Taxonomy | 183500000X Pharmacist (Licence: LA 017373) |
Enumeration Date | 2012-01-10 |
Last Update Date | 2012-01-10 |