| NPI | 1316366503 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFF WAYNE ROLLINS Mannager 228-546-3254 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: MS 19613) |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2014-04-15 |