| NPI | 1639165491 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD K FELLOWS Owner Pharmacist 975-345-5120 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: LA 078776) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: LA 078776) |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2020-08-22 |