| NPI | 1225482490 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRI SUE BUKOWSKI Manager, Outpatient Pharmacy Servic 844-881-0043 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: CT PCY.0002330) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: NY 035111) |
| 3336C0004X Pharmacy, Compounding Pharmacy (Licence: RI PHN11348) | |
| 333600000X Pharmacy (Licence: FL PH30970) | |
| Enumeration Date | 2016-04-14 |
| Last Update Date | 2025-09-29 |