| NPI | 1811039704 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AUTUMN RENEE KELLEY Pharmacy Coordinator 731-541-6277 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2025-06-02 |