| NPI | 1730724105 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDERSON JOLLY Pharmacist 877-425-6667 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy |
| Additional Taxonomies | 3336L0003X Pharmacy Long Term Care Pharmacy |
| Enumeration Date | 2019-11-09 |
| Last Update Date | 2019-11-09 |