| NPI | 1669682233 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON KELLEY COO 251-478-0758 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: AL 112240) |
| Additional Taxonomies | 3336C0004X Pharmacy, Compounding Pharmacy (Licence: AL 112240) |
| 3336M0002X Pharmacy, Mail Order Pharmacy (Licence: AL 201088) | |
| 3336C0004X Pharmacy, Compounding Pharmacy (Licence: AK 570) | |
| 3336M0002X Pharmacy, Mail Order Pharmacy (Licence: AK 570) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2020-08-22 |