| NPI | 1720468689 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL SHAWN BOAZ Pharm D 270-628-5445 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: KY P06353) |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2020-02-27 |