| NPI | 1053627943 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK ROBERT LAWSON Partner 267-979-3948 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| 335E00000X Prosthetic/Orthotic Supplier | |
| Enumeration Date | 2010-08-30 |
| Last Update Date | 2010-08-30 |