| NPI | 1801286836 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE LASCHEID CEO 239-529-2246 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251V00000X Voluntary or Charitable (Licence: FL ME30891) |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2015-01-29 |
| Last Update Date | 2015-02-11 |