| NPI | 1497790786 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSS SPIVEY Pharmacist In Charge 931-684-9987 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition (Licence: TN 0000004147) |
| Additional Taxonomies | 3336C0004X Pharmacy, Compounding Pharmacy (Licence: TN 0000004147) |
| 3336L0003X Pharmacy, Long Term Care Pharmacy (Licence: TN 0000004147) | |
| 3336S0011X Pharmacy, Specialty Pharmacy (Licence: TN 0000004147) | |
| 3336H0001X Pharmacy, Home Infusion Therapy Pharmacy (Licence: TN 0000004147) | |
| Enumeration Date | 2006-06-19 |
| Last Update Date | 2008-06-18 |