| NPI | 1871787887 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY JEROME Hc Enrollment Specialist 612-696-8312 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: MI 5301008714) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2007-09-02 |
| Last Update Date | 2015-02-02 |