Healthcare Provider Details

I. General information

NPI: 1730115619
Provider Name (Legal Business Name): BRASSTOWN PROFESSIONAL PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 02/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 MURPHY HWY STE B
BLAIRSVILLE GA
30512-3157
US

IV. Provider business mailing address

23 B MURPHY HIGHWAY
BLAIRSVILLE GA
30512
US

V. Phone/Fax

Practice location:
  • Phone: 706-745-2303
  • Fax: 706-745-2333
Mailing address:
  • Phone: 706-745-2303
  • Fax: 706-745-2333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number8635
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberD19680
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number8635
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberC22010
License Number StateGA
# 5
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number8635
License Number StateGA

VIII. Authorized Official

Name: MS. AMY S GALLOWAY
Title or Position: OWNER
Credential: R.PH., COF
Phone: 706-745-2303