| NPI | 1801854047 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BLAKE CLY GILLMAN Owner/CEO 765-265-4699 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 333600000X Pharmacy |
| Additional Taxonomies | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: IN 60000438A) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2023-03-01 |