| NPI | 1689059263 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID ROBERTSON Store Manager 541-889-6288 |
| Organization Subpart ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR 11562) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID p4856) |
| 183500000X Pharmacist (Licence: MT 27850) | |
| 183500000X Pharmacist (Licence: NV 17778) | |
| 183500000X Pharmacist (Licence: NM rp00006714) | |
| 183500000X Pharmacist (Licence: TX 29779) | |
| Enumeration Date | 2015-07-24 |
| Last Update Date | 2015-07-24 |