| NPI | 1639589690 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER D BOHANNON President 866-743-8396 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: MT PHA-WDD-LIC-21852) |
| Enumeration Date | 2014-04-30 |
| Last Update Date | 2014-04-30 |