| NPI | 1083950489 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERA HENRY Tech 931-919-2491 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: TN 5120) |
| Additional Taxonomies | 163WD0400X Registered Nurse, Diabetes Educator |
| 333600000X Pharmacy | |
| 3336C0002X Pharmacy, Clinic Pharmacy | |
| 3336C0004X Pharmacy, Compounding Pharmacy | |
| Enumeration Date | 2012-12-13 |
| Last Update Date | 2018-11-14 |