| NPI | 1366766891 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORDAN COGGIN President 866-829-3978 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy, Long Term Care Pharmacy (Licence: AL 113374) |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| 3336M0002X Pharmacy, Mail Order Pharmacy | |
| Enumeration Date | 2010-03-26 |
| Last Update Date | 2018-10-10 |