| NPI | 1104855154 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE A RIVERS Managed Care Plan Specialist 623-869-3524 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: OR 001748) |
| Additional Taxonomies | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Enumeration Date | 2006-07-02 |
| Last Update Date | 2008-11-10 |