| NPI | 1235596800 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN STAGMAN Credentialing Specialist 563-252-1121 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2016-01-27 |
| Last Update Date | 2024-10-24 |