| NPI | 1144569658 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICKEY CHANCE Corporate Officer/Owner 228-388-1327 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0004X Pharmacy Compounding Pharmacy (Licence: MS 07783/02.2) |
| Enumeration Date | 2013-02-04 |
| Last Update Date | 2013-02-04 |