| NPI | 1205145778 | 
|---|---|
| Entity Type | Organization | 
| Authorized Contact | LAM LE Pharmacist 678-731-7307 | 
| Organization Subpart ? | No | 
| Primary Taxonomy | 1835P0018X Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist (Licence: GA rph026949) | 
| Additional Taxonomies | 1835P0018X Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist (Licence: CA 64651) | 
| 1835P0018X Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist (Licence: TX 49846) | |
| Enumeration Date | 2010-10-01 | 
| Last Update Date | 2014-02-19 |