| NPI | 1952688400 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK WAGNER President 1800-763-0547 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: FL PS36358) |
| Enumeration Date | 2011-11-11 |
| Last Update Date | 2011-11-11 |