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General NPI Number Information
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NPI Number | 1114961943
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Entity Type | Organization
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Legal Business Name | TOWN AND COUNTRY PHARMACY
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 192 W CHERRY ST
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City | JESUP
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State | GA
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Zip | 31545-1309
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Country | US
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Telephone | 912-427-4310
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Fax | 912-427-3063
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Provider Business Mailing Address
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Address Line | 192 W CHERRY ST
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City | JESUP
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State | GA
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Zip | 31545-1309
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Country | US
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Telephone | 912-427-4310
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Fax | 912-427-3063
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | MR. RALPH M COVINGTON
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Credential |
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Telephone | 912-427-4310
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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 | PHRE006153
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License Number State | GA
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