| NPI | 1972832277 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM SCOTT JOHNSON Owner 702-630-1610 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: CO 427721) |
| Enumeration Date | 2009-12-15 |
| Last Update Date | 2009-12-15 |