| NPI | 1073849626 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JILL GOOCH Pharmacist 662-534-4774 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: MS 02138/01.1) |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2009-11-02 |
| Last Update Date | 2018-01-31 |