| NPI | 1295448868 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY FREEMAN Contracting & Licensing Specialist 917-472-7794 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Enumeration Date | 2022-12-28 |
| Last Update Date | 2025-06-12 |