| NPI | 1538239611 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMBER HAYCOX VP Revenue 870-210-9209 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy Long Term Care Pharmacy |
| Additional Taxonomies | 333600000X Pharmacy |
| 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: AR AR18257) | |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2022-01-20 |