| NPI | 1770822934 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIKE KISSIRE Owner 509-528-4118 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0004X Pharmacy Compounding Pharmacy (Licence: WA 3336C0004X) |
| Enumeration Date | 2013-02-07 |
| Last Update Date | 2013-02-07 |