| NPI | 1932764032 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY DELK Managing Member 516-351-0208 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy |
| Additional Taxonomies | 3336C0004X Pharmacy, Compounding Pharmacy |
| Enumeration Date | 2019-05-03 |
| Last Update Date | 2019-05-03 |