| NPI | 1710052063 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GILBERT NELSON WEISE Pharmacist Manager 904-388-1564 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: FL PH520) |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2020-08-22 |