| NPI | 1629163142 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TREVOR RAY Owner 270-651-7030 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 333600000X Pharmacy |
| 3336C0004X Pharmacy, Compounding Pharmacy | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2022-11-21 |