| NPI | 1265225270 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY G. MCDANIEL CEO 631-439-4311 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336S0011X Pharmacy, Specialty Pharmacy |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2025-05-23 |
| Last Update Date | 2025-05-23 |