| NPI | 1154700276 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID WOLSTEIN Dispensing Practitoner 813-283-1910 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: FL ME17577) |
| Enumeration Date | 2015-05-21 |
| Last Update Date | 2023-03-01 |