| NPI | 1679733034 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD BAISE Pharmacist 270-789-2165 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0004X Pharmacy, Compounding Pharmacy (Licence: KY PO6571) |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2008-06-10 |