| NPI | 1558811315 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAVIENDER BUKKAPATNAM President 813-850-0026 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: FL ME90062) |
| Enumeration Date | 2016-10-05 |
| Last Update Date | 2016-10-05 |