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General NPI Number Information
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NPI Number | 1023210044
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Entity Type | Organization
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Legal Business Name | PEACHTREE PHARMACY SERVICES
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 11/06/2007
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Provider Practice Location Address
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Address Line | 1018 SOUTH MAIN STR HWY 129 SUITE A
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City | CLEVELAND
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State | GA
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Zip | 30528
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Country | US
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Telephone | 706-865-0367
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Fax | 706-865-0931
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Provider Business Mailing Address
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Address Line | 1018 SOUTH MAIN STR HWY 129 SUITE A
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City | CLEVELAND
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State | GA
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Zip | 30528
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Country | US
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Telephone | 706-865-0367
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Fax | 706-865-0931
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | MR. JAMES CHARLES HERNDON
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Credential | RPH
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Telephone | 706-865-0367
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 014565
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License Number State | GA
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