Healthcare Provider Details

I. General information

NPI: 1063562262
Provider Name (Legal Business Name): MANSFIELD PHARMACY,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 HAMBRICK RD
STONE MTN GA
30083-3233
US

IV. Provider business mailing address

832 HAMBRICK RD
STONE MTN GA
30083-3233
US

V. Phone/Fax

Practice location:
  • Phone: 404-292-7300
  • Fax:
Mailing address:
  • Phone: 404-292-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9324
License Number StateGA

VIII. Authorized Official

Name: DAVID H MANSFIELD
Title or Position: CEO
Credential: PHARMACIST
Phone: 404-292-7300