| NPI | 1699911263 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICO MAWUN Owner 703-926-3219 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: MD P04962) |
| Additional Taxonomies | 3336C0004X Pharmacy Compounding Pharmacy |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2009-01-01 |
| Last Update Date | 2009-02-17 |