| NPI | 1902316078 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDON HAGEN Chief VP Of Operations 888-557-4318 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy Long Term Care Pharmacy |
| Additional Taxonomies | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Enumeration Date | 2017-10-03 |
| Last Update Date | 2019-12-20 |