NPI | 1174927966 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: FL ph2405) |
Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS11104) |
3336L0003X Pharmacy, Long Term Care Pharmacy | |
Enumeration Date | 2014-10-22 |
Last Update Date | 2020-01-23 |