| NPI | 1376067991 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD KELTON Credentialing 615-546-5894 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336M0002X Pharmacy, Mail Order Pharmacy (Licence: TN 5978) |
| Enumeration Date | 2017-07-26 |
| Last Update Date | 2022-07-21 |