| NPI | 1891795266 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | S GREG HAYSE Owner 502-633-2115 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: KY PO6369) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2022-07-21 |