| NPI | 1538560552 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL SELASSIE Manager 267-787-5210 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: PA PP482477) |
| Enumeration Date | 2014-09-09 |
| Last Update Date | 2015-12-30 |