| NPI | 1922380245 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MONICA FASANMI Pharmacist 817-795-8884 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: TX 27609) |
| Additional Taxonomies | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Enumeration Date | 2011-09-13 |
| Last Update Date | 2017-01-18 |