| NPI | 1184026312 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK KEVIN EMAS Owner 904-448-4174 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: FL ME67970) |
| Enumeration Date | 2014-09-18 |
| Last Update Date | 2014-09-18 |