| NPI | 1346481629 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRIS BRANTLEY Pharmacy Administrator 904-739-1309 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: FL ME54477) |
| Enumeration Date | 2009-03-16 |
| Last Update Date | 2009-03-16 |