| NPI | 1659947117 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOANIE MARIE COCHRAN Credentialing Agent 336-306-9755 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2021-06-03 |
| Last Update Date | 2025-10-28 |