| NPI | 1477598563 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSE CAMPON Legal 516-523-6948 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0004X Pharmacy Compounding Pharmacy |
| Additional Taxonomies | 333600000X Pharmacy |
| 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: NY 015799) | |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2017-08-13 |