| NPI | 1821537929 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDY BOWEN PIC/Pharmacist 870-415-1372 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 3336L0003X Pharmacy, Long Term Care Pharmacy |
| Enumeration Date | 2017-02-22 |
| Last Update Date | 2022-08-30 |