| NPI | 1518408665 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN MILLS PIC 502-716-7301 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: KY P07685) |
| Additional Taxonomies | 3336M0002X Pharmacy Mail Order Pharmacy |
| Enumeration Date | 2017-03-09 |
| Last Update Date | 2017-03-09 |