| NPI | 1184961641 |
|---|---|
| Doing Business As | SUPRX PHARMACY # 92 |
| Entity Type | Organization |
| Authorized Contact | ROBERT BRYAN MOODY PIC 843-673-9107 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy |
| Enumeration Date | 2013-01-03 |
| Last Update Date | 2013-02-25 |