| NPI | 1720482789 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN D. WILLIAMS Owner 276-964-0555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: VA 0201004074) |
| Additional Taxonomies | 332BP3500X Durable Medical Equipment & Medical Supplies Parenteral & Enteral Nutrition (Licence: VA 0201004074) |
| 333600000X Pharmacy (Licence: VA 0201004074) | |
| 3336H0001X Pharmacy Home Infusion Therapy Pharmacy (Licence: VA 0201004074) | |
| Enumeration Date | 2014-10-20 |
| Last Update Date | 2014-10-20 |