| NPI | 1437151792 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY CARL Owner 251-633-8090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AL 2003-011157) |
| Additional Taxonomies | 333600000X Pharmacy (Licence: AL 15287) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2020-08-22 |