| NPI | 1598765570 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEY SHEEHAN Credentialing Specialist 855-733-3126 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: FL PH17230) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 3336S0011X Pharmacy, Specialty Pharmacy | |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2024-12-16 |