| NPI | 1174708127 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA J COLE Vice President 855-733-3126 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336S0011X Pharmacy, Specialty Pharmacy (Licence: LA PHY.006884-IR) |
| Additional Taxonomies | 333600000X Pharmacy |
| 3336C0003X Pharmacy, Community/Retail Pharmacy | |
| Enumeration Date | 2008-01-08 |
| Last Update Date | 2020-09-30 |