| NPI | 1477564979 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEITH GOSS Owner 706-369-5822 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: GA PHRE009005) |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2025-09-11 |