| NPI | 1649307414 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROLYN BASS Manager 904-737-2216 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0004X Pharmacy, Compounding Pharmacy (Licence: FL PH528) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2020-08-22 |