| NPI | 1790926368 |
|---|---|
| Doing Business As | CONFIDENTIAL PHARMACY |
| Entity Type | Organization |
| Authorized Contact | JEFFREY LEE DERSHEM Owner 267-373-9087 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336M0002X Pharmacy, Mail Order Pharmacy |
| Enumeration Date | 2009-03-11 |
| Last Update Date | 2009-03-11 |