| NPI | 1821279498 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA LEVINE Mgr Of Gove RN Ment Contracting 479-204-8550 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: FL PH23140) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2007-11-23 |
| Last Update Date | 2023-08-30 |