| NPI | 1538694955 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUDOVICK YOUMBI Pharmacist In Charge 866-293-1559 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 3336C0004X Pharmacy, Compounding Pharmacy |
| 3336L0003X Pharmacy, Long Term Care Pharmacy | |
| 3336S0011X Pharmacy, Specialty Pharmacy | |
| Enumeration Date | 2017-04-23 |
| Last Update Date | 2020-11-11 |