| NPI | 1659380772 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY KONAK VP, Revenue Cycle Mgt 877-662-6633 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336S0011X Pharmacy Specialty Pharmacy (Licence: NY 010600) |
| Additional Taxonomies | 3336C0004X Pharmacy Compounding Pharmacy |
| 333600000X Pharmacy | |
| 3336C0003X Pharmacy Community/Retail Pharmacy | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2025-07-24 |