| NPI | 1083719843 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK WALLACE Pharmacist And Owner 423-745-3382 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: TN 116) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2008-06-05 |