| NPI | 1760992119 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUNNY YOST Pharmacy Enrollment Specialist 208-395-3920 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: NJ 28RS00325300) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2017-10-11 |
| Last Update Date | 2017-10-11 |