| NPI | 1457628752 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRTI GUPTA Pharmacist 267-258-3445 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: PA rp1003187) |
| Enumeration Date | 2011-11-30 |
| Last Update Date | 2011-11-30 |