| NPI | 1104967066 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELING BETANCOURT Owner 813-601-3373 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: FL PH21402) |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| 3336M0002X Pharmacy, Mail Order Pharmacy | |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2020-08-22 |