| NPI | 1548764103 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VIDYA DORAISWAMY Credentialing Specialist 954-680-2108 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2020-02-24 |