| NPI | 1447082136 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA YVONNE JACKSON Credentialing Manager 445-289-0400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy |
| Additional Taxonomies | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Enumeration Date | 2024-08-20 |
| Last Update Date | 2024-08-20 |