| NPI | 1083738207 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMUEL W. WALLER President 662-234-6315 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: MS 00269) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2020-08-22 |