| NPI | 1609620764 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHERWIN O DAVIS Owner/Manager 260-579-8854 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy |
| Additional Taxonomies | 3336C0004X Pharmacy, Compounding Pharmacy |
| Enumeration Date | 2024-04-15 |
| Last Update Date | 2024-04-15 |