Healthcare Provider Details

I. General information

NPI: 1982687364
Provider Name (Legal Business Name): DAHLONEGA PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 12/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 MEMORIAL DR
DAHLONEGA GA
30533-0800
US

IV. Provider business mailing address

70 MEMORIAL DR
DAHLONEGA GA
30533-0800
US

V. Phone/Fax

Practice location:
  • Phone: 706-864-2522
  • Fax: 706-864-5051
Mailing address:
  • Phone: 706-864-2522
  • Fax: 706-864-5051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE003260
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ALLISON LAYNE
Title or Position: OFFICE MGR
Credential: CPTH
Phone: 706-864-2522