| NPI | 1417954488 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACOB MILES JOHNSON Owner 256-245-4446 |
| Organization Subpart ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AL 112273) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AL 112273) |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2010-12-29 |