| NPI | 1215444252 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANAGED CARE Manager, Provider Enrollment 404-785-7876 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 333600000X Pharmacy (Licence: GA PHRE005903) |
| Additional Taxonomies | 3336I0012X Pharmacy, Institutional Pharmacy (Licence: GA PHRE005903) |
| Enumeration Date | 2017-12-29 |
| Last Update Date | 2024-09-18 |