| NPI | 1366430423 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBEKAH LYN DESARMO VP Of Finance 231-861-6902 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Additional Taxonomies | 3336C0004X Pharmacy Compounding Pharmacy |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 333600000X Pharmacy | |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2025-03-19 |