| NPI | 1134223811 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN COLBERT Dir Phcy Enrollments 401-770-2751 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: WV MP0552307) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 3336C0003X Pharmacy, Community/Retail Pharmacy | |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2023-01-18 |