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General NPI Number Information
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NPI Number | 1104551092
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Entity Type | Organization
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Legal Business Name | SAKS GA LLC
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Dates
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Enumeration Date | 07/23/2022
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Last Update Date | 02/16/2024
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Provider Practice Location Address
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Address Line | 2714 OSBORNE RD STE K
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City | SAINT MARYS
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State | GA
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Zip | 31558-4050
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Country | US
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Telephone | 904-368-6785
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 600841
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City | SAINT JOHNS
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State | FL
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Zip | 32260-0841
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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 | AO
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Name | GUNJAN WADHWA
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Credential |
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Telephone | 912-226-7622
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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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