| NPI | 1417178740 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLARK LEVI Owner 228-875-3097 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: MS MS5001) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2020-08-22 |