| NPI | 1215481460 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DUSTIN EDGE Pharmacy Supervisor 910-424-0317 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: NC 24653) |
| Enumeration Date | 2016-08-04 |
| Last Update Date | 2016-08-04 |