| NPI | 1639415425 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIKE KALBAUGH Credentialing Specialist 336-878-8824 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: GA PHRE010124) |
| Additional Taxonomies | 251F00000X Home Infusion (Licence: GA PHRE010124) |
| 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition (Licence: GA PHRE010124) | |
| 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies (Licence: GA PHWH003765) | |
| 333600000X Pharmacy (Licence: GA PHRE010124) | |
| 3336H0001X Pharmacy, Home Infusion Therapy Pharmacy (Licence: GA PHRE010124) | |
| Enumeration Date | 2012-12-24 |
| Last Update Date | 2018-08-09 |