| NPI | 1669930467 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VIPUL B MAMTORA AO 844-224-8493 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 3336L0003X Pharmacy, Long Term Care Pharmacy |
| Enumeration Date | 2019-03-11 |
| Last Update Date | 2019-05-13 |