| NPI | 1922990290 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DWAYNIE BACON Pharmacist 282-960-2389 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336M0003X Pharmacy, Managed Care Organization Pharmacy |
| Enumeration Date | 2025-07-19 |
| Last Update Date | 2025-07-19 |