Healthcare Provider Details

I. General information

NPI: 1184804445
Provider Name (Legal Business Name): SUTTON FAMILY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2007
Last Update Date: 04/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3957 CLEVELAND HWY UNIT A
DALTON GA
30721-2052
US

IV. Provider business mailing address

3957 CLEVELAND HWY UNIT A
DALTON GA
30721-2052
US

V. Phone/Fax

Practice location:
  • Phone: 706-852-1802
  • Fax: 706-852-2206
Mailing address:
  • Phone: 706-852-1802
  • Fax: 706-852-2206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE009405
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: GREGORY SUTTON
Title or Position: OWNER
Credential: RPH
Phone: 706-618-1773