| NPI | 1396259966 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAYMOND LAFAYETTE MATHIS President/Owner 662-594-1573 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: MS 16600) |
| Additional Taxonomies | 3336C0004X Pharmacy, Compounding Pharmacy |
| Enumeration Date | 2017-11-19 |
| Last Update Date | 2024-01-09 |