| NPI | 1013300128 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TOMMY TAYLOR OSBORNE President/CEO 757-777-4110 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: VA 0213001933) |
| Enumeration Date | 2015-03-13 |
| Last Update Date | 2021-11-20 |