| NPI | 1164820247 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN JENSEN President 800-511-5144 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: GA PHRE010102) |
| Additional Taxonomies | 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition |
| 3336S0011X Pharmacy, Specialty Pharmacy | |
| Enumeration Date | 2014-12-05 |
| Last Update Date | 2020-03-11 |