| NPI | 1629514989 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT LUCKOW Manager 877-629-4446 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336H0001X Pharmacy, Home Infusion Therapy Pharmacy |
| Additional Taxonomies | 333600000X Pharmacy |
| 3336C0003X Pharmacy, Community/Retail Pharmacy | |
| 3336M0002X Pharmacy, Mail Order Pharmacy | |
| 3336S0011X Pharmacy, Specialty Pharmacy | |
| Enumeration Date | 2017-01-10 |
| Last Update Date | 2022-07-21 |