NPI | 1649353970 |
---|---|
Doing Business As | MED PEDS ASSOCIATES |
Entity Type | Organization |
Authorized Contact | DIRENDIA SHACKELFORD Managed Care Specialist 800-654-0889 |
Organization Subpart ? | No |
Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: IL 036074737) |
Enumeration Date | 2006-10-23 |
Last Update Date | 2008-09-03 |