| NPI | 1073679684 |
|---|---|
| Former Legal Business Name | ST. MARY'S ROAD PHARMACY |
| Entity Type | Organization |
| Authorized Contact | KENNETH LYDELL HARRELL President 706-685-1845 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: GA PHRE008778) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2010-09-16 |