| NPI | 1104931138 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY CRUMP President 831-758-0976 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 333600000X Pharmacy (Licence: IN 60005862A) |
| 3336C0003X Pharmacy, Community/Retail Pharmacy | |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2025-09-11 |