| NPI | 1104370899 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE KURISCAK Pharmacy District Manager 774-218-5495 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: RI RPH05626) |
| Enumeration Date | 2016-08-10 |
| Last Update Date | 2016-08-10 |