| NPI | 1174639041 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STERLING G KOONCE Managing Agent 910-653-6805 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy, Long Term Care Pharmacy (Licence: NC 084535) |
| Additional Taxonomies | 3336S0011X Pharmacy, Specialty Pharmacy (Licence: NC 08435) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2020-07-30 |