| NPI | 1386129377 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANN CLAUSSEN CEO 863-291-5110 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 333600000X Pharmacy |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2018-09-26 |
| Last Update Date | 2019-09-12 |