| NPI | 1700984358 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANOHAR MIRYALA Officer 817-838-2319 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: TX 18235) |
| Additional Taxonomies | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2021-11-11 |