| NPI | 1720017445 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERICA DENIAH CRESWELL Executive Admin 405-663-4111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy, Long Term Care Pharmacy (Licence: OK 16495) |
| Additional Taxonomies | 333600000X Pharmacy (Licence: OK 14399) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2016-04-08 |