| NPI | 1720531445 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAYDI FUNK Pharmacy Manager 909-800-8977 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: MT 35395) |
| Enumeration Date | 2016-07-29 |
| Last Update Date | 2016-07-29 |