| NPI | 1518533199 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY MADDOX In Office Dispensary Manager 919-390-3987 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2021-06-03 |
| Last Update Date | 2021-11-30 |