| NPI | 1780063255 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE GALLIVAN Credentialing Specialist 727-350-1089 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: FL OS7067) |
| Enumeration Date | 2015-05-29 |
| Last Update Date | 2015-05-29 |