NPI age
14 years
Enumerated 2012-05-17
Across 961 active pharmacy providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 05 (GA) | 003124131A | |
| 01 | 2135213 | PK |
Doing-business-as, former, and alternate names recorded by NPPES.
Single-site organization. Only one practice location on file.
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