| NPI | 1861985194 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICKY L OTTS President, Managing Officer 817-239-6516 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: IL 054020787) |
| Additional Taxonomies | 3336S0011X Pharmacy Specialty Pharmacy (Licence: IL 054020787) |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2023-06-19 |