| NPI | 1811236375 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TOMMY JOE WOODARD Pharmacist In Charge 225-615-8730 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Enumeration Date | 2013-02-04 |
| Last Update Date | 2013-02-04 |