| NPI | 1518465459 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NAOMI BETH CONANT Owner 904-679-5931 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: FL PH29473) |
| Additional Taxonomies | 3336C0004X Pharmacy, Compounding Pharmacy (Licence: FL PH29473) |
| Enumeration Date | 2018-01-25 |
| Last Update Date | 2018-01-25 |