| NPI | 1750811295 |
|---|---|
| Doing Business As | SUPER 1 PHARMACY #643 |
| Entity Type | Organization |
| Authorized Contact | JIM COUSINEAU Sr. VP Of Pharmacy Operations 903-877-6829 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: LA 007485) |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Enumeration Date | 2017-06-18 |
| Last Update Date | 2017-06-18 |