| NPI | 1891159976 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SEYED ABOTALEB ALAVI Pharmacist 719-568-0470 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: CO 0013355) |
| Enumeration Date | 2016-04-05 |
| Last Update Date | 2016-04-05 |