| NPI | 1982709309 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAWN DEPORTER VP Of Pharm. Ops 225-236-1549 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: NC 12033) |
| Additional Taxonomies | 333600000X Pharmacy (Licence: NC 07849) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2014-12-05 |