| NPI | 1316249352 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEAN K. JACOB Owner 2032-123-8001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: CT pcy2190) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 3336C0003X Pharmacy, Community/Retail Pharmacy | |
| 3336C0004X Pharmacy, Compounding Pharmacy | |
| 3336S0011X Pharmacy, Specialty Pharmacy | |
| 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition | |
| Enumeration Date | 2010-11-24 |
| Last Update Date | 2015-03-09 |