| NPI | 1235172404 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES HERNDON Pharmacy Manager 678-450-9993 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336M0002X Pharmacy, Mail Order Pharmacy |
| Additional Taxonomies | 333600000X Pharmacy (Licence: GA PHRE006033) |
| 3336C0003X Pharmacy, Community/Retail Pharmacy | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2025-09-11 |