| NPI | 1972370013 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER J JENEMA Pharmacist 906-869-0999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 3336C0002X Pharmacy, Clinic Pharmacy |
| 3336L0003X Pharmacy, Long Term Care Pharmacy | |
| Enumeration Date | 2023-12-08 |
| Last Update Date | 2023-12-08 |