| NPI | 1063005155 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN RUCKER Member/Owner 662-346-8812 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2021-02-19 |
| Last Update Date | 2024-09-25 |