| NPI | 1043000813 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIYA BOYCE Regional Credentialing Specialist 301-933-7133 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2025-05-07 |
| Last Update Date | 2025-05-07 |