| NPI | 1528306081 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENNIS RAY CLARK Pharmacist / Owner 541-474-3784 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0004X Pharmacy Compounding Pharmacy (Licence: OR 2763) |
| Additional Taxonomies | 3336S0011X Pharmacy Specialty Pharmacy (Licence: OR 2763) |
| Enumeration Date | 2013-01-17 |
| Last Update Date | 2013-01-17 |