| NPI | 1134598279 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE GALLIVAN Credentialing Specialist 727-755-0693 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: FL ME89547) |
| Enumeration Date | 2015-09-18 |
| Last Update Date | 2016-08-02 |