| NPI | 1578055810 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN HORNE Owner 801-809-2656 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: CO PDO.1680000168) |
| Additional Taxonomies | 333600000X Pharmacy (Licence: CO PDO.168000168) |
| 3336C0002X Pharmacy, Clinic Pharmacy (Licence: CO PDO.168000168) | |
| Enumeration Date | 2018-06-02 |
| Last Update Date | 2018-06-02 |