| NPI | 1932442266 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNATHAN FULLER Owner 270-274-9224 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: KY P07565) |
| Additional Taxonomies | 3336C0004X Pharmacy, Compounding Pharmacy |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2013-04-04 |
| Last Update Date | 2013-11-20 |