| NPI | 1790141216 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRAVIS EZELL COO 501-992-1006 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy Long Term Care Pharmacy (Licence: AR AR20822) |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2016-01-13 |
| Last Update Date | 2025-07-23 |