| NPI | 1659410603 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY LOU MONTENERY PIC 740-393-3784 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Additional Taxonomies | 333600000X Pharmacy |
| 3336C0004X Pharmacy Compounding Pharmacy | |
| 3336L0003X Pharmacy Long Term Care Pharmacy | |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2007-11-14 |