| NPI | 1487975777 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNY HEINE Sr Director Operations 858-625-2990 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: NJ MA047072) |
| Enumeration Date | 2010-06-21 |
| Last Update Date | 2010-06-21 |