| NPI | 1912512088 |
|---|---|
| Doing Business As | PHARMACY 575 |
| Entity Type | Organization |
| Authorized Contact | MARK ANDREW POLING Member 405-401-1264 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| 3336C0002X Pharmacy, Clinic Pharmacy | |
| Enumeration Date | 2020-09-15 |
| Last Update Date | 2024-06-07 |