| NPI | 1396506036 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONY EUGENE JONES Pharmacist In Charge 800-501-0619 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0004X Pharmacy Compounding Pharmacy |
| Enumeration Date | 2024-01-19 |
| Last Update Date | 2024-01-19 |