| NPI | 1942374012 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE L ELLIS Pharmacist In Charge 813-876-0881 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy, Long Term Care Pharmacy (Licence: FL PH21000) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2020-08-22 |