| NPI | 1760193395 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAWN CHRISTIAN Provider Enrollment 989-759-6464 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Enumeration Date | 2022-12-05 |
| Last Update Date | 2022-12-05 |