| NPI | 1215037544 |
|---|---|
| Doing Business As | PHARM PHARMACY 6102 |
| Entity Type | Organization |
| Authorized Contact | MICHAEL SMITH Third Party Contract Admin 419-891-4991 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: MI 5301007193) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2008-03-31 |