| NPI | 1710870696 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SERENA ANN KIMBALL Director Of Coding And Compliance 860-263-0256 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2025-05-30 |
| Last Update Date | 2025-05-30 |