| NPI | 1053681080 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIE E. LASSALLE Credentialing Manager 925-621-2918 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: FL PH25872) |
| Enumeration Date | 2012-01-06 |
| Last Update Date | 2017-03-02 |