| NPI | 1033364138 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA SIMPSON Credentailing Specialist 907-733-2273 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2008-11-18 |
| Last Update Date | 2024-12-03 |