| NPI | 1750852455 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYSON MULLEN Member 620-355-8101 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 333600000X Pharmacy |
| 3336L0003X Pharmacy, Long Term Care Pharmacy | |
| Enumeration Date | 2018-12-07 |
| Last Update Date | 2019-06-24 |