Individual
Inactive
Sole proprietor
Provider details
NPI number
Contact information
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
E-06196
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00030254
—
MS
01
—
2506840
NABP
MS
Enumeration date
—
Last updated
—
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