MEDICARE: C & W PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy

General Provider Information

NPI Number	:	1629345376
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C & W PHARMACY

Provider Business Mailing Address
First Line	:	1032 MAIN ST
Second Line	:
City	:	FOREST PARK
State	:	GA
Zip	:	30297-1442
Country	:	US
Telephone Number	:	404-366-4320
Fax Number	:	404-366-0834

Provider Business Practice Location Address
First Line	:	1032 MAIN ST
Second Line	:
City	:	FOREST PARK
State	:	GA
Zip	:	30297-1442
Country	:	US
Telephone Number	:	404-366-4320
Fax Number	:	404-366-0834

Authorized Official
Title or Position	:	OWNER
Name	:	RAY WAYNE CRISP
Credential	:
Telephone Number	:	404-362-2990

Provider Enumeration Date	:	11/23/2011
Last Update Date	:	11/23/2011

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Directions to “C & W PHARMACY ” Practice Location

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