| NPI | 1841386448 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS RICHARD NACKEL Pharmacy Supervisor 617-248-1190 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QV0200X Clinic/Center, VA (Licence: MA 16609) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2020-08-22 |