| NPI | 1760428254 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK ANTHONY DAVIS Owner 731-589-0206 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 333600000X Pharmacy |
| 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: TN 439) | |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2018-03-23 |