| NPI | 1063976777 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PUSHPAKKUMAR D RAVAL Member 352-804-0817 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 3336M0002X Pharmacy, Mail Order Pharmacy |
| Enumeration Date | 2019-01-27 |
| Last Update Date | 2019-06-26 |