| NPI | 1598428104 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTHONY ELLIS Pharmacist In Charge 682-382-2290 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy, Long Term Care Pharmacy |
| Enumeration Date | 2021-10-20 |
| Last Update Date | 2021-10-20 |