| NPI | 1104909142 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANN WILSON Phcy Manager 910-270-1077 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: NC 08083) |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: NC 7703557) | |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2008-06-13 |