| NPI | 1679196000 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON MACK Store Leader 701-298-2918 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2020-05-20 |
| Last Update Date | 2020-05-20 |