| NPI | 1265695852 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDY L. CAMPA Providership Supervisor 800-225-5967 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336M0002X Pharmacy, Mail Order Pharmacy |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2008-07-03 |