| NPI | 1891793261 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES ROBERT OLIVER Owner 270-651-8889 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition (Licence: KY P00471) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: KY P00471) |
| 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies (Licence: KY MG0696) | |
| 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: KY P00471) | |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2015-09-25 |