| NPI | 1720005226 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW MCMULLIN Director, Contracting 479-371-8711 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: AR AR16102) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 333600000X Pharmacy | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2023-11-06 |