Healthcare Provider Details

I. General information

NPI: 1215078019
Provider Name (Legal Business Name): WYNNS PHARMACY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 GRAEFE ST
GRIFFIN GA
30224-4221
US

IV. Provider business mailing address

107 GRAEFE ST
GRIFFIN GA
30224-4221
US

V. Phone/Fax

Practice location:
  • Phone: 770-467-6500
  • Fax: 770-467-6513
Mailing address:
  • Phone: 770-467-6500
  • Fax: 770-467-6513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberPHRE008220
License Number StateGA

VIII. Authorized Official

Name: OSGOOD A. MILLER
Title or Position: OWNER
Credential: R.PH.
Phone: 770-467-6500