| NPI | 1982789459 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM B WAGNER CEO 502-774-8631 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 333600000X Pharmacy |
| 3336C0002X Pharmacy, Clinic Pharmacy | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2025-05-22 |