| NPI | 1376030080 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MACKENZIE HAHN Ncpdp Coordinator 888-590-0808 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: CA G43958) |
| Enumeration Date | 2018-04-18 |
| Last Update Date | 2018-04-18 |