| NPI | 1790772473 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNAN LYNN TRACY Pharmacist In Charge 770-939-1642 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: GA PHRE005288) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2018-04-25 |