| NPI | 1467750679 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN A WILTZ Bsd General Manager 407-936-2999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: FL PH25311) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 3336C0004X Pharmacy Compounding Pharmacy | |
| Enumeration Date | 2011-03-11 |
| Last Update Date | 2011-03-11 |