| NPI | 1982980884 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: IA 19643) |
| Additional Taxonomies | 1835P2201X Pharmacist, Ambulatory Care (Licence: IA 19643) |
| 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: IA 19643) | |
| Enumeration Date | 2011-10-24 |
| Last Update Date | 2021-09-29 |