| NPI | 1164768354 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GORDON CHEN Owner 305-628-6117 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: IL 036.131322) |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site (Licence: IL 036.131322) |
| Enumeration Date | 2012-12-17 |
| Last Update Date | 2012-12-17 |