| NPI | 1710381793 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAY KOURT President 580-661-3549 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0004X Pharmacy Compounding Pharmacy (Licence: OK 286889) |
| Additional Taxonomies | 3336C0003X Pharmacy Community/Retail Pharmacy |
| 3336S0011X Pharmacy Specialty Pharmacy | |
| 333600000X Pharmacy | |
| Enumeration Date | 2014-10-20 |
| Last Update Date | 2015-01-20 |