| NPI | 1508841917 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONNIE POE VP 662-754-2241 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: MS 00952011) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 3336C0003X Pharmacy, Community/Retail Pharmacy | |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2025-09-11 |