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General NPI Number Information
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NPI Number | 1033484837
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Entity Type | Organization
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Legal Business Name | PEACHTREE PHARMACY AND GIFTS INC
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Dates
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Enumeration Date | 03/13/2012
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Last Update Date | 09/04/2013
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Provider Practice Location Address
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Address Line | 802 PEACHTREE ST
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City | LOUISVILLE
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State | GA
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Zip | 30434-1450
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Country | US
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Telephone | 478-625-9450
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Fax | 478-625-9454
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Provider Business Mailing Address
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Address Line | PO BOX 567
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City | LOUISVILLE
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State | GA
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Zip | 30434-0567
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Country | US
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Telephone | 478-625-9450
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Fax | 478-625-9454
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | ELIZABETH MCNEELY
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Credential |
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Telephone | 478-494-4019
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHRE009845
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License Number State | GA
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