| NPI | 1891039467 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GWENDOLYN K JEFFRO Dispending 414-967-7006 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: WI 32807-31) |
| Enumeration Date | 2012-11-20 |
| Last Update Date | 2013-01-14 |