Healthcare Provider Details

I. General information

NPI: 1609061647
Provider Name (Legal Business Name): TALLAPOOSA DRUG COMPANY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 W ALABAMA ST
TALLAPOOSA GA
30176-1464
US

IV. Provider business mailing address

24 W ALABAMA ST
TALLAPOOSA GA
30176-1464
US

V. Phone/Fax

Practice location:
  • Phone: 770-574-2339
  • Fax: 770-574-7307
Mailing address:
  • Phone: 770-574-2339
  • Fax: 770-574-7307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE004796
License Number StateGA

VIII. Authorized Official

Name: RICKY GRIFFIN
Title or Position: OWNER & PIC
Credential: RPH
Phone: 770-574-2339