| NPI | 1558706440 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EMILY BROOKE BOUCHER Pharmacy Tech 907-631-6916 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QV0200X Clinic/Center, VA (Licence: AK 587) |
| Enumeration Date | 2013-05-06 |
| Last Update Date | 2013-05-06 |