NPI: 1619919040 · CHALAN PAGO, GU 96910 · Pharmacy · NPI assigned 06/11/2006
| Authorized Official | BENITO, MIKE (GENERAL MANAGER PAYLESS MRKTS) |
| NPI Enumeration Date | 06/11/2006 |
| Year | Claims | Total Paid |
|---|---|---|
| 2022 | 14 | $124.20 |
| 2023 | 13 | $124.56 |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| A4211 | Supplies for self-administered injections | 27 | 26 | $248.76 |