| NPI | 1689614026 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DALE HOUSTON Manager Of Managed Care 863-688-1188 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Additional Taxonomies | 333600000X Pharmacy (Licence: FL PH0020776) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2009-04-17 |