| NPI | 1780366450 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BAO KHOA NGUYEN Owner 863-258-0465 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2023-08-02 |
| Last Update Date | 2023-10-19 |