| NPI | 1598162679 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KISHA MOORE Sr Asc Administrator 512-341-2273 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336I0012X Pharmacy, Institutional Pharmacy |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: TX 26370) |
| Enumeration Date | 2014-12-04 |
| Last Update Date | 2026-04-17 |