| NPI | 1093849747 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL LAMENSDORF Owner 941-957-4987 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: FL DO4520) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2008-04-23 |