| NPI | 1477423671 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BLAKE WELCH BENTLEY Pharmacist In Charge 385-452-9266 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy, Long Term Care Pharmacy |
| Enumeration Date | 2025-11-11 |
| Last Update Date | 2026-02-20 |