Healthcare Provider Details

I. General information

NPI: 1760399950
Provider Name (Legal Business Name): ABUNDANT LIFE PHARMACY & HEALTH FOODS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 N MAIN ST
BAXLEY GA
31513-0070
US

IV. Provider business mailing address

117 N MAIN ST
BAXLEY GA
31513-0070
US

V. Phone/Fax

Practice location:
  • Phone: 912-367-8404
  • Fax: 912-367-8405
Mailing address:
  • Phone: 912-367-8404
  • Fax: 912-367-8405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LISA LYNN HALL
Title or Position: OWNER
Credential: PHARMACIST
Phone: 912-367-8404