| NPI | 1760566897 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDON KOENNING PIC 512-324-8820 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0004X Pharmacy Compounding Pharmacy (Licence: TX 22534) |
| Additional Taxonomies | 3336C0002X Pharmacy Clinic Pharmacy |
| 3336C0003X Pharmacy Community/Retail Pharmacy | |
| 3336C0004X Pharmacy Compounding Pharmacy | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2007-07-20 |