| NPI | 1245408830 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CICELY D EASON Executive Admin. 954-935-6063 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: FL ME57886) |
| Enumeration Date | 2008-02-15 |
| Last Update Date | 2008-02-15 |