| NPI | 1881064772 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DE'SHAWN N GRAVES Owner 850-630-6072 |
| Organization Subpart ? | No |
| Primary Taxonomy | 183700000X Pharmacy Technician |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory |
| 332100000X Department of Veterans Affairs (VA) Pharmacy | |
| 3336C0003X Pharmacy Community/Retail Pharmacy | |
| 3336C0004X Pharmacy Compounding Pharmacy | |
| 3336M0002X Pharmacy Mail Order Pharmacy | |
| Enumeration Date | 2015-10-05 |
| Last Update Date | 2015-10-05 |