| NPI | 1801975065 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK TRAMMEL Asst Treasurer 641-428-7984 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy Long Term Care Pharmacy (Licence: IA 1140) |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2024-10-10 |