| NPI | 1639587801 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNY HEINE VP Of Operations 858-964-1506 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: NJ 25MA05374000) |
| Enumeration Date | 2014-07-31 |
| Last Update Date | 2014-07-31 |