| NPI | 1912325622 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES JOSEPH MATTIODA CEO 8578-755-0288 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: CA 27898) |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2014-04-01 |