| NPI | 1679899108 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSS SPIVEY Pharmacist In Charge 931-684-9987 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336H0001X Pharmacy, Home Infusion Therapy Pharmacy (Licence: TX 0000004147) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: TN 0000004147) |
| 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition (Licence: TN 0000004147) | |
| 333600000X Pharmacy (Licence: TN 0000004147) | |
| Enumeration Date | 2010-04-08 |
| Last Update Date | 2010-04-08 |