| NPI | 1770676108 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY AVANCE Owner 405-310-2014 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: OK 174718) |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2006-09-30 |
| Last Update Date | 2008-06-11 |