| NPI | 1881731073 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA M WAGNER Owner 502-426-1788 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: KY p00851) |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2012-08-27 |