| NPI | 1447618707 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NANCY BONNER President 678-500-9568 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy |
| Additional Taxonomies | 171W00000X Contractor |
| 332900000X Non-Pharmacy Dispensing Site | |
| Enumeration Date | 2016-02-02 |
| Last Update Date | 2018-05-12 |