| NPI | 1417939794 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE SPROUL Pahrmacist In Charge 386-236-1658 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 333600000X Pharmacy (Licence: FL 0010338) |
| Additional Taxonomies | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2023-10-09 |