| NPI | 1720069628 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID WILLIAM BORDER Authorized Signer 800-225-5967 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336S0011X Pharmacy, Specialty Pharmacy |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AL 112079) |
| 333600000X Pharmacy (Licence: AL 112079) | |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2007-08-20 |