| NPI | 1295291045 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HALEY STOCKS Contracting Specialist 920-992-6800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 3336S0011X Pharmacy, Specialty Pharmacy | |
| Enumeration Date | 2019-02-18 |
| Last Update Date | 2022-04-07 |