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General NPI Number Information
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NPI Number | 1073223855
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Entity Type | Organization
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Legal Business Name | OLD NAT DRUGS, LLC
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Dates
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Enumeration Date | 12/01/2022
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Last Update Date | 12/01/2022
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Provider Practice Location Address
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Address Line | 5495 OLD NATIONAL HWY STE C2
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City | COLLEGE PARK
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State | GA
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Zip | 30349-3256
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Country | US
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Telephone | --
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Fax |
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Provider Business Mailing Address
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Address Line | 5558 VILLAGE TRCE
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City | UNION CITY
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State | GA
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Zip | 30291-5147
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | DR. LINDA DAVIS
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Credential | PHARMD
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Telephone | 843-307-5789
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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 |
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License Number State |
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