| NPI | 1568682144 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY WAINE JACKSON Pharmacist President 817-226-5050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336S0011X Pharmacy, Specialty Pharmacy (Licence: TX 17649) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2020-08-22 |