Healthcare Provider Details

I. General information

NPI: 1245692862
Provider Name (Legal Business Name): NEIGHBORHOOD IMPROVEMENT PROJECT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 05/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 E BROAD ST
WRENS GA
30833-1185
US

IV. Provider business mailing address

2467 GOLDEN CAMP RD
AUGUSTA GA
30906-5515
US

V. Phone/Fax

Practice location:
  • Phone: 706-547-2550
  • Fax: 706-547-3765
Mailing address:
  • Phone: 706-922-0682
  • Fax: 706-922-0683

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 NumberPHRE010271
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PURNANK GANDHI
Title or Position: DIRECTOR OF PHARMACY
Credential:
Phone: 706-922-0682