| NPI | 1124476502 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA 449982) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA 028025) |
| 183500000X Pharmacist (Licence: WV 0009366) | |
| 183500000X Pharmacist (Licence: SC 35644) | |
| 183500000X Pharmacist (Licence: OH 3135423) | |
| Enumeration Date | 2016-05-26 |
| Last Update Date | 2020-11-30 |