| NPI | 1508619768 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLE DOUGLAS TALLEY CFO 985-974-6008 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0004X Pharmacy Compounding Pharmacy |
| Additional Taxonomies | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Enumeration Date | 2024-04-08 |
| Last Update Date | 2024-04-08 |