| NPI | 1659834026 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER J SMITH Cmo 386-615-5008 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336M0003X Pharmacy, Managed Care Organization Pharmacy |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2019-04-11 |
| Last Update Date | 2025-04-22 |