| 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 |