| NPI | 1659072874 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY FREEMAN Contracting & Licensing Specialist 323-475-1495 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Enumeration Date | 2023-03-14 |
| Last Update Date | 2025-06-04 |