Healthcare Provider Details

I. General information

NPI: 1942295142
Provider Name (Legal Business Name): HUTCHESON MEDICAL CENTER EMPLOYEE PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 GROSS CRESCENT CIR
FT OGLETHORPE GA
30742-3643
US

IV. Provider business mailing address

100 GROSS CRESCENT CIR
FT OGLETHORPE GA
30742-3643
US

V. Phone/Fax

Practice location:
  • Phone: 706-858-2279
  • Fax: 706-858-2676
Mailing address:
  • Phone: 706-858-2279
  • Fax: 706-858-2676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHRE004853
License Number StateGA

VIII. Authorized Official

Name: MR. CARL J. HALE
Title or Position: PHARMACY DIRECTOR
Credential: R.P.H.
Phone: 706-858-2277