| NPI | 1790280717 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM KYLE KIITZKE President 318-398-2100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy, Long Term Care Pharmacy (Licence: LA PHY.006459-IR) |
| Enumeration Date | 2018-03-30 |
| Last Update Date | 2023-05-24 |