| NPI | 1114969417 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD CANADA Owner 757-562-3333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 333600000X Pharmacy (Licence: VA 0201002758) |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: VA 0201002758) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2008-04-08 |