| NPI | 1912304197 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VANCE T WALL CEO / Owner 678-985-7246 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 333600000X Pharmacy | |
| 3336L0003X Pharmacy Long Term Care Pharmacy | |
| Enumeration Date | 2014-12-03 |
| Last Update Date | 2019-06-13 |