| NPI | 1396166633 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALBERT WALTER JETER PIC 843-367-1164 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 3336C0003X Pharmacy, Community/Retail Pharmacy | |
| Enumeration Date | 2014-01-03 |
| Last Update Date | 2023-08-15 |