| NPI | 1104255652 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER JAMES CHEN Owner 305-628-6117 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: FL ME88821) |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2013-11-05 |
| Last Update Date | 2013-11-18 |