| NPI | 1962711770 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SRIKANTH PONNADA Staff Pharmacist 541-314-3271 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: NM RP00007444) |
| Enumeration Date | 2010-09-28 |
| Last Update Date | 2010-09-28 |