| NPI | 1447688452 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PRAVEEN ANANTHULA Pharmacy Manager 4072-876-6727 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Enumeration Date | 2013-10-30 |
| Last Update Date | 2017-04-12 |