| NPI | 1750626453 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY WALSH Director Of Pharmacy Operations 888-843-2040 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: NY 031623) |
| Additional Taxonomies | 3336S0011X Pharmacy, Specialty Pharmacy (Licence: NY 031623) |
| Enumeration Date | 2012-12-06 |
| Last Update Date | 2019-10-29 |