| NPI | 1730612953 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTOR B PERINI Assistant Secretary 314-684-6273 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: AZ Y002074) |
| Additional Taxonomies | 3336M0002X Pharmacy, Mail Order Pharmacy (Licence: AZ Y002074) |
| Enumeration Date | 2017-04-05 |
| Last Update Date | 2019-10-07 |