| NPI | 1629517453 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MACKENZIE HAHN Ncpdp Coordinator 479-636-9702 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: LA MD.201144) |
| Enumeration Date | 2017-02-13 |
| Last Update Date | 2017-11-16 |