| NPI | 1215130372 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY L SPONSLER Owner 907-376-6523 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: AK 5128) |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site (Licence: AK 5128) |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2011-01-20 |