| NPI | 1760408611 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIRENDIA SHACKELFORD Managed Care Spec Allscri PT S 800-654-0889 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: FL ME64328) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2020-08-22 |