Healthcare Provider Details

I. General information

NPI: 1962452003
Provider Name (Legal Business Name): SURREY CENTER PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 10/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

483 HIGHLAND AVE
AUGUSTA GA
30909-3912
US

IV. Provider business mailing address

483 HIGHLAND AVE
AUGUSTA GA
30909-3912
US

V. Phone/Fax

Practice location:
  • Phone: 706-738-4558
  • Fax: 706-738-9246
Mailing address:
  • Phone: 706-738-4558
  • Fax: 706-738-9246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. EARL G WRIGHT
Title or Position: OWNER
Credential: R.PH.
Phone: 706-738-4558