| NPI | 1700965811 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDELL GLENN SULLIVAN Owner 662-563-7687 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: MS 00481/01.1) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2020-08-22 |