| NPI | 1174111546 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLIE MARIE VILE Pharmacy Manager 888-611-2941 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336M0002X Pharmacy, Mail Order Pharmacy |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 3336S0011X Pharmacy, Specialty Pharmacy | |
| Enumeration Date | 2021-01-01 |
| Last Update Date | 2022-09-01 |