| NPI | 1972806875 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA MANTOOTH Director Of Billing / Ar 808-791-9333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: HI PHY-789) |
| Enumeration Date | 2010-12-15 |
| Last Update Date | 2010-12-15 |