| NPI | 1225032659 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA G STOUDENMIRE Owner 251-460-0300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: AL 111212) |
| Additional Taxonomies | 333600000X Pharmacy (Licence: AL 200547) |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AL 4900 41002) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AL 2005-009446) | |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2011-04-09 |