| NPI | 1982719936 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARLA AHLGRIMM Owner 800-558-7046 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: WI 8093042) |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2020-08-22 |