| NPI | 1629276563 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT H LOMENICK Owner 662-252-2446 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336S0011X Pharmacy, Specialty Pharmacy (Licence: MS 02246 02.6) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MS 02246 02 6) |
| 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: MS 02246 02.6) | |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2011-06-21 |