| NPI | 1528439775 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARYL A HUNTSINGER Contracts Administrator 564-999-3950 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 333600000X Pharmacy (Licence: WA PHAR.CF.60488322) |
| Enumeration Date | 2015-10-14 |
| Last Update Date | 2025-05-08 |