| NPI | 1659300622 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE ANN RIVERS Managed Care Plan Specialist 623-869-3524 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Additional Taxonomies | 333600000X Pharmacy (Licence: TX 22087) |
| Enumeration Date | 2006-07-02 |
| Last Update Date | 2017-05-26 |