| NPI | 1245794502 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JON ROBERT LUEDTKE Pharmacist In Charge 239-772-8866 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy Long Term Care Pharmacy |
| Enumeration Date | 2019-01-30 |
| Last Update Date | 2019-01-30 |