| NPI | 1598783763 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW POLK Chief Operating Officer 254-313-4412 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Additional Taxonomies | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2025-07-02 |