| NPI | 1083361968 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARLOS BLACK Owner 662-803-3858 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2022-03-09 |
| Last Update Date | 2022-03-09 |