NPI | 1073308896 |
---|---|
Entity Type | Organization |
Authorized Contact | ROSALIE KREIGHBAUM Regional Credentialing Specialist 314-909-1920 |
Organization Subpart ? | No |
Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
Enumeration Date | 2025-04-11 |
Last Update Date | 2025-04-11 |