| NPI | 1659365294 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIA JOANN GOFF In Charge Pharmacist 870-483-6439 |
| Organization Subpart ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AR 69889) |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2020-08-22 |