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1346530847
JACK EDWARD FUNDERBURK
MOULTRIE, GA
NPI
1346530847
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
183500000X Pharmacist
(Licence: GA RPH010666)
Enumeration Date
2011-04-18
Last Update Date
2011-04-18
Business Address
Mr. JACK EDWARD FUNDERBURK
305 6TH ST SE
MOULTRIE, GA 31768-4842
Phone number: 229-984-1378
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Mailing Address
Mr. JACK EDWARD FUNDERBURK
305 6TH ST SE
MOULTRIE, GA 31768-4842
Phone number: 229-984-1378
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