| NPI | 1063833267 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN P OUDERKIRK Member 404-588-4680 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: GA 049992) |
| Enumeration Date | 2013-12-16 |
| Last Update Date | 2013-12-16 |