| NPI | 1568551372 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BOBBY JAMES RUSSELL Director Of Pharmacy 731-885-9441 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies (Licence: TN 466) |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier (Licence: TN RFM00719) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2008-02-29 |