Healthcare Provider Details

I. General information

NPI: 1992536148
Provider Name (Legal Business Name): BRASSTOWN PROFESSIONAL PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
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 MURPHY HWY STE B
BLAIRSVILLE GA
30512-3157
US

V. Phone/Fax

Practice location:
  • Phone: 706-455-8123
  • Fax: 706-745-2333
Mailing address:
  • Phone: 706-745-2303
  • Fax: 706-745-2333

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: AMY S COLE
Title or Position: VP/OWNER PHARMACIST
Credential: R.PH.
Phone: 706-745-2303