| NPI | 1780101816 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILSON LEE KREZDORN Owner 903-707-2034 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: TX 31557) |
| Additional Taxonomies | 333600000X Pharmacy (Licence: TX 31557) |
| Enumeration Date | 2017-08-29 |
| Last Update Date | 2022-07-21 |