| NPI | 1629097779 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL RENEE ORANGE Assistant System Controller 270-338-8276 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336I0012X Pharmacy, Institutional Pharmacy (Licence: KY P07696) |
| Additional Taxonomies | 333600000X Pharmacy |
| 3336L0003X Pharmacy, Long Term Care Pharmacy | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2017-12-29 |