| NPI | 1679857304 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM KYLE KLITZKE President 318-398-2100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: LA PHY.006459-IR) |
| Additional Taxonomies | 3336L0003X Pharmacy Long Term Care Pharmacy |
| Enumeration Date | 2011-09-29 |
| Last Update Date | 2023-05-25 |