| NPI | 1518192442 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY A PANK Paralegal 502-420-2666 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy, Long Term Care Pharmacy (Licence: IA 4555) |
| Additional Taxonomies | 3336L0003X Pharmacy, Long Term Care Pharmacy (Licence: IL 054017160) |
| 3336L0003X Pharmacy, Long Term Care Pharmacy (Licence: MN 263807) | |
| 3336L0003X Pharmacy, Long Term Care Pharmacy (Licence: MO 2012006851) | |
| Enumeration Date | 2009-05-21 |
| Last Update Date | 2017-03-24 |