NPI | 1023428521 |
---|---|
Entity Type | Organization |
Authorized Contact | LYNN J. GOODLOE Medical Director 818-518-5980 |
Organization Subpart ? | Yes |
Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: CA G44674) |
Enumeration Date | 2014-05-06 |
Last Update Date | 2015-10-05 |