| NPI | 1598181000 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH WAYNE BAILES Pharmacist In Charge/Owner 580-759-6238 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0004X Pharmacy, Compounding Pharmacy (Licence: OK 23-6620) |
| Enumeration Date | 2014-03-07 |
| Last Update Date | 2014-03-07 |