| NPI | 1912340829 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARL LAKE STANLEY Member 229-520-5151 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy, Long Term Care Pharmacy (Licence: GA PHRE009911) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: GA PHRE009911) |
| Enumeration Date | 2013-04-10 |
| Last Update Date | 2017-05-04 |