| NPI | 1972730828 |
|---|---|
| Former Legal Business Name | NO |
| Entity Type | Organization |
| Authorized Contact | DEWARRENT L. BRANTLEY CEO/ President 318-678-0709 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0002X Pharmacy, Clinic Pharmacy |
| Enumeration Date | 2009-06-18 |
| Last Update Date | 2009-06-18 |