| NPI | 1992137582 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA LEVINE Mgr Gove RN Ment Contracting 479-204-8550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: MA DS89890) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2013-08-06 |
| Last Update Date | 2015-12-31 |