| NPI | 1376201186 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSE THOMAS VEGA Administration Official 939-588-9337 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 333600000X Pharmacy |
| 3336C0002X Pharmacy, Clinic Pharmacy | |
| Enumeration Date | 2021-11-30 |
| Last Update Date | 2021-11-30 |