| NPI | 1629635479 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRANT S. DINO CEO/Owner 888-660-6715 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336C0004X Pharmacy, Compounding Pharmacy |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2019-05-28 |
| Last Update Date | 2019-05-28 |