| NPI | 1104503663 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SEBASTIAN FONSECA Credential Specialist 956-379-5667 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Enumeration Date | 2023-06-28 |
| Last Update Date | 2023-10-11 |