| NPI | 1902852395 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEMOND HAWKINS Third Party Manager 208-395-3905 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: CT PCY0001673) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 333600000X Pharmacy | |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2018-01-23 |