| NPI | 1538378468 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BILLIE JAMES BONNER Owner 662-226-8825 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: MS 01331) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2008-03-18 |