| NPI | 1710091608 |
|---|---|
| Doing Business As | 14TH AVENUE COMMUNITY FIRST PHARMACY |
| Entity Type | Organization |
| Authorized Contact | SCOTT LOUDERBACK President 402-489-1135 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: WA CF00058660) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2008-06-25 |