| NPI | 1679948541 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE SISKO Credentialing Specialist 727-483-7463 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: FL ME106734) |
| Enumeration Date | 2015-12-03 |
| Last Update Date | 2015-12-03 |