| NPI | 1144304783 |
|---|---|
| Doing Business As | PRIME |
| Entity Type | Organization |
| Authorized Contact | DIRENDIA SHACKELFORD Managed Care Specialist 800-654-0889 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: RI MD10232) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2020-08-22 |