| NPI | 1720356264 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HAROLD CARTER Pharmacist In Charge 800-986-5164 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: CA C0867846) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: CA C0867846) |
| 3336M0002X Pharmacy, Mail Order Pharmacy (Licence: CA C0867846) | |
| Enumeration Date | 2011-12-12 |
| Last Update Date | 2011-12-12 |