| NPI | 1508378845 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAIN RUSK VP Pharmacy 863-688-1188 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 333600000X Pharmacy (Licence: AL 114781) |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2017-10-26 |
| Last Update Date | 2020-01-03 |