| NPI | 1538618459 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN EUGENE BURR Secretary 712-310-4701 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2016-10-04 |
| Last Update Date | 2024-02-13 |