| NPI | 1972643914 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA ETTLEMAN Owner 712-374-2513 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: IA 507) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2018-02-12 |