| NPI | 1720005861 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA LEVINE Mgr Of Gove RN Ment Contracting 479-204-8550 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: WV MP0552315) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 333600000X Pharmacy | |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2023-08-29 |