| NPI | 1235668435 |
|---|---|
| Doing Business As | IMA BVL DISPENSARY |
| Entity Type | Organization |
| Authorized Contact | PATRICIA PICHARDO COO 407-845-0330 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2017-06-09 |
| Last Update Date | 2017-06-09 |