| NPI | 1396200770 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSS A. DAVIDSON Registered Agent 307-921-1228 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Enumeration Date | 2019-02-09 |
| Last Update Date | 2022-05-12 |