| NPI | 1710243860 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY NEAL Owner 502-287-2763 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2012-04-03 |
| Last Update Date | 2012-04-03 |