| NPI | 1487108015 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID LOTH Owner 669-999-6870 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: CA PHY54414) |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2016-08-11 |
| Last Update Date | 2016-09-21 |