| NPI | 1003172792 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACOB TYLER WALLACE President 704-922-3001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: NC 09048) |
| Enumeration Date | 2012-04-06 |
| Last Update Date | 2021-09-21 |