| NPI | 1760232169 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN SCOTT BRYNER Sr Director, Pharmacy 385-375-6453 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336S0011X Pharmacy, Specialty Pharmacy |
| Enumeration Date | 2024-03-26 |
| Last Update Date | 2024-03-26 |