| NPI | 1962055186 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRITTANY CAUDILL Tech/Manager 219-487-1879 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0004X Pharmacy Compounding Pharmacy |
| Additional Taxonomies | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Enumeration Date | 2019-07-17 |
| Last Update Date | 2019-07-17 |