| NPI | 1114108735 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEITH JAMES MATTHEWS Pharmacist In Charge 706-869-9799 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services |
| 3336C0004X Pharmacy, Compounding Pharmacy | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2007-11-26 |
| Last Update Date | 2022-05-02 |