| NPI | 1104076694 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENA WOLFORTH Program Manager 843-745-8636 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336M0002X Pharmacy, Mail Order Pharmacy |
| Additional Taxonomies | 302R00000X Health Maintenance Organization |
| Enumeration Date | 2008-09-22 |
| Last Update Date | 2008-09-22 |