| NPI | 1356973804 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER JARVENE SHACKELFORD Pharmacist, Pharmacy Manager 662-591-5234 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Enumeration Date | 2020-02-12 |
| Last Update Date | 2023-01-06 |