| NPI | 1396158135 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SID ILANGOVAN Pharmacist 304-222-3064 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: WV MP0552410) |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2021-11-18 |