| NPI | 1780683730 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHERYL MCINTOSH Administrator 352-248-2032 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: FL ME24996) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME24996) |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2009-08-03 |