| NPI | 1902565542 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SMIKAL J PATEL License Officer 770-723-9460 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336M0002X Pharmacy, Mail Order Pharmacy |
| Additional Taxonomies | 333600000X Pharmacy |
| 3336L0003X Pharmacy, Long Term Care Pharmacy | |
| Enumeration Date | 2021-12-10 |
| Last Update Date | 2022-02-02 |