| NPI | 1285107466 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LANCE MILLER Pharmacist In Charge 251-550-5025 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Enumeration Date | 2019-01-09 |
| Last Update Date | 2019-01-09 |