NPI age
20 years
Enumerated 2005-12-27
Across 961 active pharmacy providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 (GU) | PHRE008007 | STATE LISC NUMBER |
| 01 (GU) | 1142998 | NCPDP # |
| 05 (GA) | 00714887A |
Doing-business-as, former, and alternate names recorded by NPPES.
Single-site organization. Only one practice location on file.
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