| NPI | 1679931687 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASMINE WORTHEN Credentialing Specialist 727-755-0693 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: NV 9064) |
| Enumeration Date | 2016-02-04 |
| Last Update Date | 2022-11-22 |