| NPI | 1396830980 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORA LYNN MORA Owner 913-538-7582 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: KS 6-00316) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2022-07-21 |