| NPI | 1922469865 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRISTAN SHOCKLEY Owner 240-786-1001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: MD D0068884) |
| Enumeration Date | 2016-03-18 |
| Last Update Date | 2016-03-18 |