Healthcare Provider Details

I. General information

NPI: 1013072693
Provider Name (Legal Business Name): ARMUCHEE PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4334 MARTHA BERRY HWY NE
ROME GA
30165-8642
US

IV. Provider business mailing address

4334 MARTHA BERRY HWY NE
ROME GA
30165-8642
US

V. Phone/Fax

Practice location:
  • Phone: 706-235-1303
  • Fax: 706-235-8239
Mailing address:
  • Phone: 706-235-1303
  • Fax: 706-235-8239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: AUSTIN RATLIFF
Title or Position: OWNER
Credential:
Phone: 706-235-1303