| NPI | 1003232984 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MT 5340) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AK 1704) |
| 183500000X Pharmacist (Licence: ID 6774) | |
| 183500000X Pharmacist (Licence: WA 60277915) | |
| 183500000X Pharmacist (Licence: OR 0013468) | |
| 183500000X Pharmacist (Licence: HI 3478) | |
| Enumeration Date | 2014-03-14 |
| Last Update Date | 2014-03-14 |