| NPI | 1619067683 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE FRANK BROWER Rph Owner 641-713-4381 |
| Organization Subpart ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: IA 13613) |
| Additional Taxonomies | 333600000X Pharmacy (Licence: IA 177) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2020-08-22 |