| NPI | 1558610527 |
|---|---|
| Doing Business As | REVIVE PHARMACY |
| Entity Type | Organization |
| Authorized Contact | NICOLE DEFORTE Owner 239-204-4223 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: FL PH26342) |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2012-09-05 |
| Last Update Date | 2016-02-26 |