| NPI | 1487997359 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA HILL Senior Credentialing COO Rdinator 502-272-5165 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: KY P07552) |
| Additional Taxonomies | 3336C0004X Pharmacy Compounding Pharmacy |
| 332800000X Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 333600000X Pharmacy | |
| Enumeration Date | 2013-03-29 |
| Last Update Date | 2021-09-22 |