| NPI | 1104230176 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW C WALK CEO 833-765-3648 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336H0001X Pharmacy, Home Infusion Therapy Pharmacy (Licence: AZ Y005972) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ Y005972) |
| 333600000X Pharmacy (Licence: AZ Y005972) | |
| 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: AZ Y005972) | |
| 3336S0011X Pharmacy, Specialty Pharmacy (Licence: AZ Y005972) | |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2023-07-10 |