| NPI | 1932186780 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA LONG V.P. 386-698-3737 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: WV MP0551276) |
| Additional Taxonomies | 333600000X Pharmacy (Licence: VA 0214000228) |
| 333600000X Pharmacy (Licence: OH 02193) | |
| 333600000X Pharmacy (Licence: AR X01570) | |
| 333600000X Pharmacy (Licence: NC 07117) | |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2009-04-22 |