| NPI | 1487661591 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYANT MOSHANG Controller 410-910-1500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: PA 3000008031) |
| Additional Taxonomies | 333600000X Pharmacy (Licence: PA PP414715L) |
| 333600000X Pharmacy (Licence: DE A9-0000656) | |
| 333600000X Pharmacy (Licence: SC 60009067) | |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2023-03-07 |