| NPI | 1588132328 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOVIE N. BRIDGEWATER Anesthesiologist 662-349-2659 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2018-11-09 |
| Last Update Date | 2020-02-03 |