| NPI | 1558762120 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM G. HUDSON Owner 702-503-5852 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: NV NV20141517285) |
| Enumeration Date | 2014-09-14 |
| Last Update Date | 2014-09-14 |