| NPI | 1700507548 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MACY NICHOLE GREGORY Chief Pharmacist 304-626-2549 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QP2400X Clinic/Center, Prison Health |
| Additional Taxonomies | 3336C0002X Pharmacy, Clinic Pharmacy |
| Enumeration Date | 2022-09-09 |
| Last Update Date | 2022-09-09 |