| NPI | 1932227089 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY MATTHEW FORTENBERRY Pharmacist Ni Charge 601-937-1672 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: MS 06748) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2023-03-07 |