| NPI | 1255698791 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAZEN BAISA Owner 855-246-6338 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: MI 5301009790) |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2012-04-23 |
| Last Update Date | 2012-04-23 |