| NPI | 1457732653 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID EUGENE CLARK Pharmacist In Charge 662-455-6809 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: MS 14368/1.1) |
| Enumeration Date | 2015-06-12 |
| Last Update Date | 2015-06-12 |