| NPI | 1205720398 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSALIE KREIGHBAUM Regional Credentialing Specialist 314-909-1920 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2025-06-04 |
| Last Update Date | 2025-06-04 |