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General NPI Number Information
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NPI Number | 1114012119
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Entity Type | Organization
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Legal Business Name | SUMMERVILLE PHARMACY
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3087 WESTWOOD RD HANI MUSSAD
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City | AUGUSTA
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State | GA
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Zip | 30909
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Country | US
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Telephone | 706-736-2093
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Fax | 706-733-7301
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Provider Business Mailing Address
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Address Line | 2258 WRIGHTSBORO RD SUITE 150
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City | AUGUSTA
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State | GA
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Zip | 30904
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Country | US
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Telephone | 706-481-7140
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Fax | 706-733-7301
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Authorized Official
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Title or Position | OWNER/ PHARMACIST
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Name | HANI WILLIAM MUSSAD
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Credential | BS
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Telephone | 706-481-7140
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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 | RPH.004193
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License Number State | GA
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