| NPI | 1033102884 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON IVY Business Director 662-513-7690 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy Long Term Care Pharmacy |
| Additional Taxonomies | 333600000X Pharmacy (Licence: MS 00959/03.1) |
| Enumeration Date | 2005-08-26 |
| Last Update Date | 2018-06-14 |