| NPI | 1902993108 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN LATOCHA PIC 304-436-3380 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: WV SP0550088) |
| 3336C0003X Pharmacy, Community/Retail Pharmacy | |
| Enumeration Date | 2006-10-07 |
| Last Update Date | 2020-03-15 |