NPI | 1912679523 |
---|---|
Entity Type | Organization |
Authorized Contact | ANN CLAUSSEN CEO 863-291-5110 |
Organization Subpart ? | Yes |
Primary Taxonomy | 333600000X Pharmacy |
Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
Enumeration Date | 2021-10-01 |
Last Update Date | 2021-10-01 |