| NPI | 1174627996 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN COLBERT Director, Managed Care Admin 401-770-2751 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: OH 02-1208450) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 3336C0003X Pharmacy Community/Retail Pharmacy | |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2012-03-08 |