| NPI | 1225848005 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICKY SOU Supervising Pharmacist 347-374-6260 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 3336S0011X Pharmacy, Specialty Pharmacy |
| Enumeration Date | 2025-01-13 |
| Last Update Date | 2025-04-08 |