| NPI | 1396821633 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TEAL D. RABON Pharmacy Director 800-861-4965 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: SC 50009229) |
| Enumeration Date | 2006-10-30 |
| Last Update Date | 2008-02-19 |