| NPI | 1811230014 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY CHEN Authorized Official 305-831-4722 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: IL 036.131322) |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site (Licence: IL 036.131322) |
| Enumeration Date | 2013-04-05 |
| Last Update Date | 2024-10-31 |