| NPI | 1932614096 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM AUSTIN Director 662-597-1776 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: MS 16705) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MS 16705) |
| Enumeration Date | 2017-12-11 |
| Last Update Date | 2017-12-11 |