| NPI | 1104284868 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ARIANA BEDOYA Credentialing Specialist 727-755-0693 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: CO DR0039792) |
| Enumeration Date | 2016-02-09 |
| Last Update Date | 2016-02-09 |