| NPI | 1194126128 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNA SHAMILOVA Owner 347-782-5974 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: PA PP482510) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: PA PP482510) |
| Enumeration Date | 2014-09-09 |
| Last Update Date | 2016-11-16 |