| NPI | 1669826178 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY CORDISCO Owner/President/PIC/AO 239-989-9152 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: FL PH30057) |
| Additional Taxonomies | 3336C0004X Pharmacy Compounding Pharmacy |
| 333600000X Pharmacy | |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2017-03-30 |