Healthcare Provider Details

I. General information

NPI: 1396383444
Provider Name (Legal Business Name): SENOIA DRUG CO INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2019
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 NEWNAN CROSSING BLVD E STE 100
NEWNAN GA
30265-2558
US

IV. Provider business mailing address

PO BOX 280
SENOIA GA
30276-0280
US

V. Phone/Fax

Practice location:
  • Phone: 770-876-9910
  • Fax:
Mailing address:
  • Phone: 770-313-1570
  • Fax:

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 B HAZELTON
Title or Position: CEO
Credential: PHARM D
Phone: 770-876-9910