| NPI | 1962811893 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COREY LEE KOONCE Pharmacy Manager 252-937-2161 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: NC 23744) |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: VA 202212187) |
| Enumeration Date | 2014-08-05 |
| Last Update Date | 2014-08-05 |