MEDICARE: MRS. MARY M. ELKINS PHARMACIST

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	183500000X	Pharmacist	11302	GA

General Provider Information

NPI Number	:	1750509295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY M. ELKINS PHARMACIST

Provider Business Mailing Address
First Line	:	8204 AUGUSTA ROAD
Second Line	:	QUICK RX
City	:	GARDEN CITY
State	:	GA
Zip	:	31408
Country	:	US
Telephone Number	:	912-968-5665
Fax Number	:	912-964-9699

Provider Business Practice Location Address
First Line	:	8204 AUGUSTA ROAD
Second Line	:	QUICK RX
City	:	GARDEN CITY
State	:	GA
Zip	:	31408
Country	:	US
Telephone Number	:	912-966-5665
Fax Number	:	912-964-9699

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2007
Last Update Date	:	07/25/2014

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