| NPI | 1518675446 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AISHA LYNN DEPRIEST Director Of Credentialing 844-646-3247 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy, Long Term Care Pharmacy |
| Additional Taxonomies | 3336C0002X Pharmacy, Clinic Pharmacy |
| 3336I0012X Pharmacy, Institutional Pharmacy | |
| 3336S0011X Pharmacy, Specialty Pharmacy | |
| Enumeration Date | 2022-11-09 |
| Last Update Date | 2022-11-09 |