| NPI | 1013927557 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | T BISHOP Owner 2568-782-1111 |
| Organization Subpart ? | |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AL 111152) |
| Additional Taxonomies | 332BP3500X Durable Medical Equipment & Medical Supplies Parenteral & Enteral Nutrition (Licence: AL 111152) |
| 333600000X Pharmacy (Licence: AL 111152) | |
| 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: AL 111152) | |
| 3336H0001X Pharmacy Home Infusion Therapy Pharmacy (Licence: AL 111152) | |
| 3336L0003X Pharmacy Long Term Care Pharmacy (Licence: AL 111152) | |
| 3336M0002X Pharmacy Mail Order Pharmacy (Licence: AL 111152) | |
| 3336S0011X Pharmacy Specialty Pharmacy (Licence: AL 111152) | |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2020-08-22 |