NPI | 1508221912 |
---|---|
Entity Type | Organization |
Authorized Contact | NICOLE SISKO Credentialing Specialist 727-755-0693 |
Organization Subpart ? | No |
Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: FL ME80485) |
Enumeration Date | 2015-12-30 |
Last Update Date | 2015-12-30 |