| NPI | 1114051042 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYNN BARHAM Pharmacist 662-562-8042 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: 069016517) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2020-08-22 |