| NPI | 1215336508 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK HENDRIXSON Owner 931-456-8435 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: TN 021724) |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2014-08-22 |
| Last Update Date | 2023-07-24 |