| NPI | 1902961618 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARKEL KYLE FREEMAN Owner 334-727-0047 |
| Organization Subpart ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AL 12782) |
| Additional Taxonomies | 3336S0011X Pharmacy, Specialty Pharmacy (Licence: AL 12782) |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AL 12782) | |
| 3336C0004X Pharmacy, Compounding Pharmacy (Licence: AL 12782) | |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2014-10-02 |