| NPI | 1740823202 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER THOMAS-ROLOFF Practice Administrator 678-942-5985 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Enumeration Date | 2019-10-28 |
| Last Update Date | 2021-05-18 |