| NPI | 1104352335 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAMEAN WILLIAM FREAS CEO 410-571-2946 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: NJ 25MA09802600) |
| Enumeration Date | 2017-05-09 |
| Last Update Date | 2023-01-25 |