| NPI | 1205823309 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID ROBERSON Rph 803-484-6115 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition (Licence: SC 8364) |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: SC 8364) |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: SC 20160142) | |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2016-12-28 |