| NPI | 1760575583 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER MARK VANRAAM COO 205-703-6760 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336H0001X Pharmacy, Home Infusion Therapy Pharmacy (Licence: TN 3332) |
| Additional Taxonomies | 3336L0003X Pharmacy, Long Term Care Pharmacy (Licence: TN 3332) |
| 3336S0011X Pharmacy, Specialty Pharmacy | |
| 261QI0500X Clinic/Center, Infusion Therapy (Licence: TN TN3332) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: TN 3332) | |
| 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition (Licence: TN 3332) | |
| 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: TN 3332) | |
| 3336C0004X Pharmacy, Compounding Pharmacy (Licence: TN 3332) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2021-05-19 |