| NPI | 1124215603 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANYA SULLIVAN Employee Pharmacy Supervisor/PIC 478-542-7981 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: GA PHRE009387) |
| Additional Taxonomies | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Enumeration Date | 2007-09-28 |
| Last Update Date | 2016-05-11 |