| NPI | 1174695233 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONNIE BAGWELL Owner And President 601-932-2027 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: MS 01771/1.1) |
| Additional Taxonomies | 3336C0004X Pharmacy Compounding Pharmacy |
| 333600000X Pharmacy | |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2017-03-01 |