| NPI | 1417990680 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES PAGE Pharm D, Director Of Pharmacy 826-824-3822 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy Long Term Care Pharmacy (Licence: CT PCY0001824) |
| Additional Taxonomies | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2016-08-18 |