| NPI | 1043767445 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHERRY CARLSON Pharmacist 855-718-7759 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: OR 9003) |
| Enumeration Date | 2016-09-02 |
| Last Update Date | 2016-09-02 |