| NPI | 1720595465 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALAN CARL GUSTAVSON Director Of Pharmacy 269-685-9807 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: MI 5301011309) |
| Enumeration Date | 2018-01-03 |
| Last Update Date | 2018-04-23 |