Healthcare Provider Details

I. General information

NPI: 1659475606
Provider Name (Legal Business Name): ZOOT ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 05/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 TURNER MCCALL BLVD SW
ROME GA
30161-2927
US

IV. Provider business mailing address

832 TURNER MCCALL BLVD SW
ROME GA
30161-2927
US

V. Phone/Fax

Practice location:
  • Phone: 706-291-7850
  • Fax: 706-291-0575
Mailing address:
  • Phone: 706-291-7850
  • Fax: 706-291-0575

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 NumberPHRE007324
License Number StateGA

VIII. Authorized Official

Name: ANN MOSS
Title or Position: VP
Credential: RPH
Phone: 706-291-7850