| NPI | 1902454523 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER SULLIVANT Vice President/Owner 662-934-3039 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Enumeration Date | 2019-08-27 |
| Last Update Date | 2019-12-05 |