| NPI | 1871989087 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT MICHAEL DERNER Pharmacist 941-330-6147 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center Community Health (Licence: AZ S021138) |
| Enumeration Date | 2015-04-14 |
| Last Update Date | 2015-04-14 |