| NPI | 1720528409 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN LISSER Managing Member 609-703-5097 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: NJ 25MA08297500) |
| Enumeration Date | 2017-03-01 |
| Last Update Date | 2017-03-01 |