| NPI | 1427191154 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KHALIL LYNN CROUSE President 870-538-5510 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: AR 65032) |
| Additional Taxonomies | 3336L0003X Pharmacy, Long Term Care Pharmacy |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2020-02-07 |