| NPI | 1508356536 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYDELL BANCROFT MORRISON Owner 772-301-1095 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: FL PH31413) |
| Additional Taxonomies | 3336L0003X Pharmacy Long Term Care Pharmacy |
| Enumeration Date | 2018-05-15 |
| Last Update Date | 2020-04-30 |