| NPI | 1790013530 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY KONAK VP, Revenue Cycle Mgt 877-662-6633 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336S0011X Pharmacy, Specialty Pharmacy |
| Additional Taxonomies | 333600000X Pharmacy |
| 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: MA DS89702) | |
| Enumeration Date | 2009-12-04 |
| Last Update Date | 2025-07-25 |