| NPI | 1508426081 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SOMMER PEDERSEN Owner And Manager 307-463-8400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| 3336C0004X Pharmacy, Compounding Pharmacy | |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2019-06-18 |