| NPI | 1902385354 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MACKENZIE HAHN Ncpdp Coordinator 855-296-3757 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: LA MD017658) |
| Enumeration Date | 2018-08-07 |
| Last Update Date | 2018-08-07 |