| NPI | 1609271220 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JT LEATHERWOOD Owner, PIC, AO 256-230-6200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: AL 114500) |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2014-10-24 |
| Last Update Date | 2018-01-19 |