| NPI | 1396470209 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLENN SHIELDS Pharmacy Manager 704-301-4651 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 3336C0004X Pharmacy, Compounding Pharmacy |
| Enumeration Date | 2022-07-24 |
| Last Update Date | 2024-09-30 |