| NPI | 1003491689 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GISELE PEAN PIC 866-749-8679 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336M0002X Pharmacy, Mail Order Pharmacy |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 333600000X Pharmacy | |
| Enumeration Date | 2021-03-15 |
| Last Update Date | 2021-03-16 |