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General NPI Number Information
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NPI Number | 1063563419
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Entity Type | Organization
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Legal Business Name | BRYNWOOD PHARMACY INC
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Dates
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Enumeration Date | 01/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3547 WALTON WAY EXT
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City | AUGUSTA
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State | GA
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Zip | 30909-1821
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Country | US
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Telephone | 706-733-7701
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Fax | 706-733-7746
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Provider Business Mailing Address
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Address Line | 3547 WALTON WAY EXT
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City | AUGUSTA
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State | GA
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Zip | 30909-1821
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Country | US
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Telephone | 706-733-7701
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Fax | 706-733-7746
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Authorized Official
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Title or Position | PRESIDENT
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Name | RALPH GUY WONG
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Credential | PHARMACIST
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Telephone | 706-733-7701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHRE002890
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License Number State | GA
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