| NPI | 1316351125 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHERINE V. MODICA Owner 877-513-8012 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: WA NT60336456) |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2014-06-19 |