| NPI | 1720883713 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIYA BOYCE Regional Credentialing Speicialist 301-933-7133 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2025-02-14 |
| Last Update Date | 2025-02-21 |