| NPI | 1750831723 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TROY PORTER Pharmacist 636-279-0175 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: MN 123065) |
| Enumeration Date | 2016-10-13 |
| Last Update Date | 2016-10-13 |