| NPI | 1164968624 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FORD MUNDY Owner 601-990-9497 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: MS 15113/1.1) |
| Additional Taxonomies | 333600000X Pharmacy |
| 3336C0004X Pharmacy Compounding Pharmacy | |
| Enumeration Date | 2017-01-09 |
| Last Update Date | 2017-03-27 |