Organization
INTEGRATIVE MODALITY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LORRAINE D JACKSON PHARM D (DIRECTOR)
(954) 816-6703
Entity
Organization
Contact information
Practice address
12555 ORANGE DR, #4079, DAVIE, FL 33330-4304
(954) 862-1720
Mailing address
12555 ORANGE DR, #4079, DAVIE, FL 33330-4304
(954) 862-1720
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
28002
FL
Other
Enumeration date
04/01/2014
Last updated
04/01/2014
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