| NPI | 1992176192 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY WEBB CEO 3237-743-7908 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336S0011X Pharmacy, Specialty Pharmacy |
| Additional Taxonomies | 332100000X Department of Veterans Affairs (VA) Pharmacy |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 3336M0002X Pharmacy, Mail Order Pharmacy | |
| 347C00000X Private Vehicle | |
| Enumeration Date | 2015-10-13 |
| Last Update Date | 2015-10-13 |