| NPI | 1053039743 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC J LARSON Authorized Member 407-750-9313 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy |
| Additional Taxonomies | 3336C0002X Pharmacy Clinic Pharmacy |
| 3336S0011X Pharmacy Specialty Pharmacy | |
| Enumeration Date | 2022-08-18 |
| Last Update Date | 2022-08-18 |