NPI | 1215444252 |
---|---|
Entity Type | Organization |
Authorized Contact | LOUETTA CODY Manager, Provider Enrollment 404-785-7876 |
Organization Subpart ? | Yes |
Primary Taxonomy | 333600000X Pharmacy (Licence: GA PHRE005903) |
Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: GA PHRE005903) |
3336I0012X Pharmacy, Institutional Pharmacy (Licence: GA PHRE005903) | |
Enumeration Date | 2017-12-29 |
Last Update Date | 2023-04-03 |