| NPI | 1851997076 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAVIS WEIDENBACH Pharmacy Manager 307-746-3742 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Enumeration Date | 2020-12-11 |
| Last Update Date | 2020-12-11 |