| NPI | 1497963540 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFF JACKSON Member 317-803-3436 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: IN 60005496a) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2020-08-22 |