| NPI | 1336192939 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK BRADFORD President 662-536-0384 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy Long Term Care Pharmacy (Licence: MS 0595626) |
| Additional Taxonomies | 3336S0011X Pharmacy Specialty Pharmacy |
| 3336C0003X Pharmacy Community/Retail Pharmacy | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2014-07-11 |