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General NPI Number Information
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NPI Number | 1053332015
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Entity Type | Organization
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Legal Business Name | LEE GOODRUM PHARMACY INC
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 04/25/2016
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Provider Practice Location Address
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Address Line | 40 HOSPITAL RD
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City | NEWNAN
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State | GA
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Zip | 30263-1201
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Country | US
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Telephone | 770-253-1121
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Fax | 770-253-3572
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Provider Business Mailing Address
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Address Line | 40 HOSPITAL RD
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City | NEWNAN
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State | GA
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Zip | 30263-1201
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Country | US
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Telephone | 770-253-1121
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Fax | 770-253-3572
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Authorized Official
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Title or Position | CEO
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Name | JOHN GOODRUM
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Credential | BS PHARMACY
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Telephone | 770-253-1121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHRE006304
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License Number State | GA
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