| NPI | 1881984557 |
|---|---|
| Other Name | PAL GEORGIA |
| Entity Type | Organization |
| Authorized Contact | TIMOTHY TYLER WHOBREY Provider Enrollment 502-630-7249 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: GA PHRE009744) |
| Additional Taxonomies | 3336L0003X Pharmacy, Long Term Care Pharmacy (Licence: GA PHRE009744) |
| Enumeration Date | 2011-04-14 |
| Last Update Date | 2020-01-09 |