| NPI | 1083563712 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAWRENCE LAZELLE ANDERSON President/Owner 903-521-6143 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2026-01-26 |
| Last Update Date | 2026-01-26 |