| NPI | 1720592983 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA GONZALEZ Ncpdp COO Rdinator 479-636-9702 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: TN DO0000001134) |
| Enumeration Date | 2017-11-27 |
| Last Update Date | 2017-11-27 |