| NPI | 1528415791 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUZANNE P TAGG PIC/Pharmacy Owner 844-646-2279 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 3336C0003X Pharmacy, Community/Retail Pharmacy | |
| Enumeration Date | 2016-05-18 |
| Last Update Date | 2019-04-03 |