Healthcare Provider Details

I. General information

NPI: 1083020333
Provider Name (Legal Business Name): SENOIA DRUG COMPANY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 07/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 MAIN ST UNIT 1
GRANTVILLE GA
30220-3402
US

IV. Provider business mailing address

PO BOX 280
SENOIA GA
30276-0280
US

V. Phone/Fax

Practice location:
  • Phone: 770-583-9973
  • Fax:
Mailing address:
  • Phone: 770-313-1570
  • Fax: 770-727-3067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JAMES BRYAN HAZELTON
Title or Position: PHARMACIST
Credential: PHARM.D.
Phone: 770-876-9910