| NPI | 1982759569 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENISE JASON Contracts Administrator 253-218-0862 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: MN 262961) |
| Additional Taxonomies | 3336L0003X Pharmacy Long Term Care Pharmacy (Licence: MN 262961) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2020-08-22 |