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General NPI Number Information
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NPI Number | 1023721057
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Entity Type | Individual
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Provider Name | CHARLES ELLIS MONCRIEF RPH
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Gender | Male
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Dates
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Enumeration Date | 01/04/2023
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Last Update Date | 01/04/2023
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Provider Practice Location Address
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Address Line | 3155 ROYAL DR STE 100
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City | ALPHARETTA
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State | GA
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Zip | 30022-2476
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Country | US
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Telephone | 770-468-1026
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Fax |
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Provider Business Mailing Address
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Address Line | 209 SHERATON DR
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City | GRIFFIN
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State | GA
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Zip | 30224-5047
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Country | US
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Telephone | 770-468-1026
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | RPH034048
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License Number State | GA
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