| NPI | 1508223140 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHLEEN VAES Owner 813-205-4550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: FL ME67888) |
| Enumeration Date | 2016-01-27 |
| Last Update Date | 2021-01-19 |