| NPI | 1912005513 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAE ANN GIBSON Manager 239-455-3124 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: FL PH11992) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2020-08-22 |