| NPI | 1326023664 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY BRIAN KRIDER Owner 920-499-6772 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2005-12-09 |
| Last Update Date | 2020-08-22 |