| NPI | 1457628109 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAY WAYNE CRISP Owner 404-362-2990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0002X Pharmacy Clinic Pharmacy |
| Additional Taxonomies | 333600000X Pharmacy |
| 3336L0003X Pharmacy Long Term Care Pharmacy | |
| 3336S0011X Pharmacy Specialty Pharmacy | |
| Enumeration Date | 2011-11-23 |
| Last Update Date | 2011-11-23 |