MEDICARE: JAMES LINDSEY HARRELL RPH

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	11500	GA

General Provider Information

NPI Number	:	1790105989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES LINDSEY HARRELL RPH

Provider Business Mailing Address
First Line	:	320 EAGER RD
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31602-1358
Country	:	US
Telephone Number	:	229-244-0262
Fax Number	:

Provider Business Practice Location Address
First Line	:	2111 BEMISS RD
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31602-1940
Country	:	US
Telephone Number	:	229-242-2070
Fax Number	:

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

Provider Enumeration Date	:	04/26/2014
Last Update Date	:	04/26/2014

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