| NPI | 1447876172 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTIE RENEA DOUGLAS Owner 817-341-6706 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2020-06-18 |
| Last Update Date | 2021-07-20 |