| NPI | 1578259438 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY NERON Credentialing Specialist 228-363-0500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Enumeration Date | 2023-04-13 |
| Last Update Date | 2024-01-16 |