| NPI | 1053776468 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRETT PUCKETT President 904-634-0640 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: FL ME80485) |
| Enumeration Date | 2015-12-30 |
| Last Update Date | 2022-09-29 |