Healthcare Provider Details

I. General information

NPI: 1255471173
Provider Name (Legal Business Name): MARTINEZ APOTHECARY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 03/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3830 WASHINGTON RD STE 11 A
MARTINEZ GA
30907-5064
US

IV. Provider business mailing address

3830 WASHINGTON RD STE 11 A
MARTINEZ GA
30907-5064
US

V. Phone/Fax

Practice location:
  • Phone: 706-210-6654
  • Fax: 706-210-8017
Mailing address:
  • Phone: 706-210-6654
  • Fax: 706-210-8017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE008753
License Number StateGA

VIII. Authorized Official

Name: NEIL W GRICE
Title or Position: PRESIDENT
Credential:
Phone: 706-210-6654