| NPI | 1184951337 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN CALLOSOE Secretary 770-596-6998 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336S0011X Pharmacy, Specialty Pharmacy (Licence: GA PHRE009616) |
| Additional Taxonomies | 333600000X Pharmacy (Licence: GA PHRE009616) |
| 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: GA PHRE009616) | |
| Enumeration Date | 2009-11-09 |
| Last Update Date | 2009-11-09 |