| NPI | 1699427989 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER GUNDERSON VP Of Pharmacy Operations 888-500-4711 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0004X Pharmacy, Compounding Pharmacy |
| Additional Taxonomies | 183500000X Pharmacist |
| Enumeration Date | 2022-01-19 |
| Last Update Date | 2022-01-19 |