| NPI | 1669271706 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KERRIN SURETTE Sr. Payor Credentialing Specialist 508-862-5048 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2025-03-11 |
| Last Update Date | 2025-03-11 |