| NPI | 1104983899 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHORETTE BENNETT DICKENS Pharmacy Manager 863-682-6880 |
| Organization Subpart ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS18682) |
| Additional Taxonomies | 333600000X Pharmacy (Licence: FL PH10343) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2020-08-22 |