| NPI | 1295105310 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE SISKO Credentialing Specialist 727-483-7463 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: FL PO1121) |
| Enumeration Date | 2015-10-01 |
| Last Update Date | 2015-10-01 |