| NPI | 1821608134 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LANAESHA TOLES Pharmacist In Charge 662-712-1478 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Enumeration Date | 2020-08-03 |
| Last Update Date | 2021-08-25 |