| NPI | 1386293041 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARCO RENELL MIDDLETON Pharmacist/PIC 870-830-7768 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Enumeration Date | 2019-09-05 |
| Last Update Date | 2020-11-10 |