| NPI | 1568101236 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK JEFFREY WARD Pharmacist In Charge 423-638-7552 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy Long Term Care Pharmacy |
| Enumeration Date | 2022-06-01 |
| Last Update Date | 2022-06-01 |