NPI | 1295161404 |
---|---|
Entity Type | Organization |
Authorized Contact | ROBERT LANCE JOHANSEN Owner 228-328-2400 |
Organization Subpart ? | No |
Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: MS 14698) |
Enumeration Date | 2013-09-19 |
Last Update Date | 2013-09-19 |