| NPI | 1477386977 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE LYN BIDWELL Operations Coordinator 270-901-3431 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy, Long Term Care Pharmacy |
| Enumeration Date | 2024-08-21 |
| Last Update Date | 2024-08-21 |