| NPI | 1053612119 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE SANDERS Pharmacy Compliance Manager 770-712-5654 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336M0003X Pharmacy Managed Care Organization Pharmacy (Licence: GA PHRE009710) |
| Enumeration Date | 2010-11-05 |
| Last Update Date | 2021-08-04 |