| NPI | 1891722898 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK PICKENS Owner 813-885-3444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: FL 3980120428317) |
| Additional Taxonomies | 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition (Licence: FL 3980120428317) |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2020-08-22 |