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General NPI Number Information
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NPI Number | 1083987457
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Entity Type | Organization
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Legal Business Name | SGBS HOLDINGS LLC
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Dates
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Enumeration Date | 02/16/2012
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Last Update Date | 03/27/2012
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Provider Practice Location Address
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Address Line | 606 BRANNEN ST STE B
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City | STATESBORO
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State | GA
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Zip | 30458-5184
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Country | US
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Telephone | 912-225-9279
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Fax |
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Provider Business Mailing Address
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Address Line | 606 BRANNEN ST STE B
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City | STATESBORO
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State | GA
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Zip | 30458-5184
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Country | US
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Telephone | 912-225-9279
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | STACEY GIRARDEAU
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Credential |
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Telephone | 912-839-5456
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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 | PHRE009817
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License Number State | GA
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