| NPI | 1982113163 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA TIEFENTHALER CEO 712-264-6391 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: IA 571) |
| Enumeration Date | 2017-09-20 |
| Last Update Date | 2023-10-10 |