| NPI | 1003940750 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEA ANN NORMAN Office Manager 662-665-9660 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MS 05606) |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: MS 05606) |
| 3336C0004X Pharmacy, Compounding Pharmacy (Licence: MS 05606) | |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2020-08-22 |