| NPI | 1235505272 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONI PIDCOCK VP 855-747-5555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 302R00000X Health Maintenance Organization |
| 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition | |
| 3336M0002X Pharmacy, Mail Order Pharmacy | |
| 333600000X Pharmacy | |
| 311ZA0620X Custodial Care Facility, Adult Care Home | |
| Enumeration Date | 2015-08-13 |
| Last Update Date | 2015-10-13 |