| NPI | 1790063428 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ADRIENNE MIGNON KLINGSMITH Pharmacist In Charge 660-385-2167 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MO 2008030097) |
| Enumeration Date | 2011-07-29 |
| Last Update Date | 2011-11-18 |