| NPI | 1093866212 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES EDWARD PETKOVSEK Mannger 972-542-4481 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 333600000X Pharmacy (Licence: TX 01911) |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2020-08-22 |