| NPI | 1902261316 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE SISKO Credentialing Specialist 727-755-0693 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: FL ME80485) |
| Enumeration Date | 2015-12-30 |
| Last Update Date | 2015-12-30 |