| NPI | 1104222629 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRISTA TANYA TYNER Pharmacist In Charge 843-455-2434 |
| Organization Subpart ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA RPH027610) |
| Enumeration Date | 2014-11-11 |
| Last Update Date | 2014-11-11 |