| NPI | 1043776057 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHESTER WILSON Executive Director 386-675-0098 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Enumeration Date | 2019-02-14 |
| Last Update Date | 2019-02-14 |