| NPI | 1609083419 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD V CUEVAS Owner 541-687-8666 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: OR OR1824T) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2020-08-22 |