| NPI | 1700073905 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY CARLTON JENKINS Owner 601-649-4418 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MS 05068/11.1) |
| Additional Taxonomies | 3336S0011X Pharmacy, Specialty Pharmacy (Licence: MS 05321/02.5) |
| Enumeration Date | 2007-10-02 |
| Last Update Date | 2011-04-19 |