| NPI | 1467975284 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TREVOR THERIOT President 657-266-0069 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: CA 103-035557) |
| Enumeration Date | 2017-07-24 |
| Last Update Date | 2017-07-24 |