NPI age
15 years
Enumerated 2011-03-09
Across 8384 active pharmacist providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 (SC) | 12058 | SC PHARMACY LICENSE |
| 01 (GA) | RPH018336 | PHARMACY LICENSE |
Part of a multi-provider practice. 18 other active providers share this practice address in NPPES.
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