| NPI | 1659448934 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROL J WEILAND Owner Pharmacist 662-358-4500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336H0001X Pharmacy, Home Infusion Therapy Pharmacy (Licence: MS 04428 02.0) |
| Additional Taxonomies | 333600000X Pharmacy (Licence: AR OS01422) |
| 3336C0004X Pharmacy, Compounding Pharmacy (Licence: MS 04428 02.0) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MS 04428/02.0) | |
| 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition (Licence: MS 04428/02.0) | |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2010-07-12 |