NPI | 1750099859 |
---|---|
Entity Type | Organization |
Authorized Contact | AISHA LYNN DEPRIEST Director Of Credentialing 844-646-3247 |
Organization Subpart ? | No |
Primary Taxonomy | 3336L0003X Pharmacy Long Term Care Pharmacy |
Additional Taxonomies | 3336C0002X Pharmacy Clinic Pharmacy |
3336I0012X Pharmacy Institutional Pharmacy | |
3336S0011X Pharmacy Specialty Pharmacy | |
Enumeration Date | 2022-11-08 |
Last Update Date | 2022-11-08 |