| NPI | 1811322753 |
|---|---|
| Doing Business As | GOLDEN TRIANGLE PDD PHARMACY |
| Entity Type | Organization |
| Authorized Contact | RUPERT L JOHNSON Executive Director 662-324-7860 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336L0003X Pharmacy Long Term Care Pharmacy |
| Additional Taxonomies | 305S00000X Point of Service (Licence: MS F12603) |
| 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: MS F12603) | |
| Enumeration Date | 2013-09-11 |
| Last Update Date | 2018-09-28 |