Healthcare Provider Details

I. General information

NPI: 1942798012
Provider Name (Legal Business Name): WEAVERS ROCKY FACE PHARMACY GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 11/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 OLD CHATTANOOGA RD
ROCKY FACE GA
30740-8511
US

IV. Provider business mailing address

630 TI PI LN
CHATSWORTH GA
30705-7786
US

V. Phone/Fax

Practice location:
  • Phone: 706-259-0668
  • Fax: 706-259-1890
Mailing address:
  • Phone: 706-259-0668
  • Fax: 706-971-3893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE010622
License Number StateGA

VIII. Authorized Official

Name: PAUL P BRYANT
Title or Position: CFO
Credential: RPH
Phone: 706-260-7998