| NPI | 1902516297 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TREVOR DEAN STARK Owner 718-484-9803 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2022-11-29 |
| Last Update Date | 2025-01-15 |