Healthcare Provider Details

I. General information

NPI: 1386710481
Provider Name (Legal Business Name): ALAN R MCELVEEEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 10/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 THOMPSON BRIDGE RD
GAINESVILLE GA
30501-1779
US

IV. Provider business mailing address

PO BOX 391
GAINESVILLE GA
30503-0391
US

V. Phone/Fax

Practice location:
  • Phone: 770-534-7675
  • Fax: 770-718-9451
Mailing address:
  • Phone: 770-534-7675
  • Fax: 770-718-9451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE006668
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ALAN MCELVEEN
Title or Position: OWNER
Credential:
Phone: 770-534-7675